Você está na página 1de 502

LAPORAN PELAYANAN PEMBEDAHAN

DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO


BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK
OPERASI SPESIAL DOKTER RWT JDWL OP KAT. LUKA OP BIAYA
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
ISASI OPERATOR INAP
KH B S K POST OP HESI ronde EL CY B BK K KTR U BPJS
L P
1 373805 An.Amrullah Rafie 6bln √ Umum 1/2/2017 Incisi Abces frontal dr.Hernowo LA III 1/I √ √ √ √

2 390749 Ny.Kamdari 44th √ Umum Exterpasi Fam dr.Hernowo Masker II 4/I √ √ √

3 390892 An.M.Ibrahim 1th √ Umum Herniotomy dr.Hernowo SAB III 2/I √ √ √

4 287647 Ny.Maryam 52th √ Umum Mastectomy dr.Hernowo Intubasi III 2/II √ √ √

5 390929 Tn.Jumain 57th √ Umum Herniotomy dr.Hernowo SAB III 3/I √ √ √

6 66380 Ny.Siti Maimunah 35th √ Obgyn Curetage dr.Kery SAB II/VK 2/III √ √ √

7 387540 Ny.Siti Munawaroh 46th √ Umum Sub total lobectomy dr.Bambang Intubasi II 4/I √ √ √

8 266667 Ny.Lilik Minarti 52th √ Umum Cholecystectomy dr.Bambang SAB II 2/III √ √ √


9 376227 Ny.Nur Rakhmayanti 30th √ Obgyn LSCS dr.Umi SAB II 3/III √ √ √
10 391170 Ny.Dwi Ayuningtyas 21th √ Obgyn LSCS dr.Umi SAB II 2/IV √ √ √

11 390325 Ny.Nunik Retnowati 30th √ Obgyn LSCS dr.Umi SAB II 3/II √ √ √

12 220353 Ny.Azmil Umrotin 36th √ Obgyn LSCS dr.Umi SAB III 2/V √ √ √

13 379741 Ny.Hesti Herawati 33th √ Obgyn LSCS + IUD dr.Umi SAB I 3/IV √ √ √

14 221954 Ny.Nur Wulandari 24th √ Obgyn 1/3/2017 Couterisasi + Exterpasi Tu dr.Heru B SAB II 1/I √ √ √

15 390259 Ny.Warsih Suprapti 52th √ Umum Sub total lobectomy dr.Sukarno Intubasi II 2/I √ √ √

16 390461 Ny.Masitah 29th √ Obgyn LSCS dr.Kery SAB II 3/I √ √ √

17 391089 Sdr.Aris Dilla 22th√ √ Umum Reposisi + psg gibs dr.Sukarno Intubasi III 2/III √ √ √

18 390756 Tn.Mat Panggih 56th √ Umum Fistulektomy dr.Bambang SAB II 1/I √ √ √

19 293504 Ny.Eli Fitriyah 33th √ Obgyn 1/4/2017 LSCS dr.Haris SAB II/VK 2/I √ √ √

20 330888 Ny.Evi Kurniasari 27th √ Obgyn LSCS + IUD dr.Umi SAB II/VK 3/I √ √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
21 390354 Ny.Rukiyah 35th √ Umum Excisi TU dr.Bambang TIVA I 2/II √ √ √

22 365060 Ny.Udaiyah 55th √ Umum Debridement + amputasi dr.Hernowo SAB I 1/II √ √ √

23 334221 Ny.Yonaria 30th √ Obgyn 05/01/2017 LSCS dr.Kery SAB II/vk 2/II √ √

24 390166 Ny.Ismawati 37th √ Obgyn LSCS dr.Haris SAB II/vk 3/II √ √

25 390829 Ny.Sumiati 55th √ Umum Paraidectomy dr.Sukarno intubasi III 4/I √ √

26 390180 Ny.Khamidiyah 28th √ Umum Sub total lobectomy dr.Sukarno intubasi III 4/II √ √ √

27 317895 Ny.Ira Susanti 32th √ Obgyn LSCS dr.Kery SAB I 3/I √ √

28 391444 Ny.Umi Lestari 48th √ Obgyn debridement+reheacting dr.Kery SAB II/vk 1/I √ √

29 390834 Ny.Sulistyaningsih 38th √ Obgyn LSCS+MOW dr.Haris SAB II/vk 2/II √ √

30 391273 Ny.Heni Wulandari 29th √ Obgyn LSCS dr.Haris SAB II/vk 2/III √ √

31 254965 Ny.Lucia Krisnawati 33th √ Obgyn LSCS dr.Haris SAB II/vk 3/III √ √

32 319106 Ny.Erlina Wibiyanti 44th √ Umum Incisi+debridement dr.Hernowo masker II 1/II √ √

33 35841 Tn.Sholikin 44th √ Umum aff plate mandibula dr.Hernowo intubasi PAV 4/III √ √

34 093198 Ny.Atik Mulyani 31th √ Obgyn LSCS dr.Umi SAB II/vk 3/III √ √

35 391417 An.Vachrie 10th √ Urologi Circumsisi dr.Kristianto masker VIPA 2/IV √ √

36 262508 Ny.Erfa Isnaini 33th √ Obgyn LSCS+Insersi IUD dr.Umi SAB III/vk 2/V √ √

37 346865 Ny.Widyaningsih 41th √ Obgyn SOS dr.Umi SAB II/vk 3/V √ √

38 391426 Tn.Sukari 42th √ Umum 06/01/2017 Excisi tu coli dr.Hernowo TIVA III 1/I √ √
39 391054 Ny.Samiyah 29th √ Umum Exterpasi lipoma dr.Hernowo TIVA III 2/II √ √

40 390981 Tn.Alimin 33th √ Umum Excisi tu gluteus dr.Bambang TIVA II 3/I √ √


KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
41 391400 Tn.Imron Rosyadi 33th √ Umum Haemoroidectomy dr.Hernowo SAB II 1/II √ √

42 391051 Ny.Anita Weni 29th √ Umum Excisi fam dr.Hernowo TIVA II 2/I √ √

43 391523 Ny.Nikmatul M 24th √ Obgyn LSCS dr.Umi SAB II/vk 3/II √ √

44 049862 Ny.Sri Lestari 65th √ Ortho AMP dr.Hari C SAB PAV 4/I √

45 391607 Ny.Dyan Ayu R 24th √ Obgyn 07/01/2017 LSCS dr.Kery SAB II/vk 2/I √ √

46 391192 Ny.Miftakhul Ana 32th √ Obgyn LSCS dr.Umi SAB II/vk 3/I √ √

47 390766 Ny.Aseh 59th √ Umum Excisi tu humerus dr.Hernowo TIVA I 1/I √ √

48 391173 Ny.Deviska Permata 23th √ Obgyn LSCS dr.Umi SAB II 2/I √ √

49 349800 Ny.Putu Ayu Diah 43th √ Obgyn 09/01/2017 SVH+SOD dr.Kery SAB I 3/I √ √

50 318352 Ny.Lidia Rini 45th √ Umum Excisi tu occipital dr.Bambang masker I 2/I √ √

51 391563 Tn.Agung Prasetyo 36th √ Umum Appendictomy dr.Bambang SAB II 1/I √ √

52 388595 Nn.Aryani Widya 22th √ Umum Sub total lobectomy dr.Hernowo intubasi II 4/I √ √

53 173238 Tn.Askur 48th √ Umum Nekrotomi+debridement dr.Hernowo SAB VIPB 1/II √ √

54 342824 Ny.Fatonah 41th √ Umum Excisi tu mamae dr.Hernowo masker I 2/II √ √

55 374272 Ny.Rininta A 27th √ Obgyn 1/10/2017 LSCS dr.Kery SAB II/vk 2/I √ √
√ Obgyn TAH dr.Kery
56 390668 Ny.Siti Mudayati 42th SAB II/vk 2/II √ √
ekplorasi Release repair
√ Umum sygmoid dr.Sukarno

57 196653 Ny.Erni Suprapti 25th √ Obgyn LSCS dr.Kery SAB I/vk 3/I √ √

58 116333 Ny.Dewi Sunawiyah 36th √ Obgyn LSCS+MOW dr.Kery SAB II/vk 3/II √ √

59 273027 Ny.Triani 39th √ Obgyn SVH dr.Kery SAB II/vk 3/III √ √

60 388977 Ny.Kasminah 44th √ Obgyn LSCS+MOW dr.Umi SAB II/vk 1/I √ √


KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
61 391604 Nn.Nurul Chumairoh 14th √ Umum Appendictomy dr.Hernowo SAB III 1/II √ √

62 390558 Tn.Soehardi 75th √ Umum Herniotomy dr.Hernowo SAB I 3/III √ √


CBD+rest
63 313707 Tn.Endra Sugeng 53th √ digestive Laparatomy re exploresi dr.Taufan SAB 2/III √ √

64 389619 Ny.Maria Tri W 37th √ Obgyn 1/11/2017 LSCS+MOW dr.Haris SAB II/vk 2/I √ √

65 391460 Ny.Annaeny Nurul 33th √ Obgyn LSCS dr.Haris SAB II/vk 2/II √ √

66 391852 Ny.Yumrotun 39th √ Obgyn LSCS dr.Haris SAB III/vk 3/II √ √

67 391932 Ny.Ika Mayasari 28th √ Obgyn LSCS dr.Kery SAB II/vk 3/I √ √

68 391923 Ny.Widi Astuti 51th √ Obgyn Couter dr.Haris SAB II/vk 2/III √ √

69 391782 Tn.Wendi Pranata 36th √ Umum Exterpasi giant lipoma dr.Sukarno SAB I 1/I √ √

70 390383 Ny.Titah Ayu 23th √ Obgyn LSCS dr.Umi SAB III/vk 2/II √ √

71 390871 Ny.Yatik Ul Hidayati 38th √ Obgyn LSCS+MOW dr.Umi SAB II/vk 3/III √ √

72 329353 Ny.Tarkini 34th √ Obgyn 1/12/2017 LSCS dr.Kery SAB II/vk 3/I √ √

73 392018 Ny.Cicik Fitriani 32th √ Obgyn LSCS+Histerectomy dr.Kery SAB III/vk 3/II √ √

74 391779 Ny.Weny Rimba 25th √ Obgyn LSCS dr.Kery SAB II/vk 2/I √ √

75 390684 Ny.Suyati 44th √ Obgyn SOD dr.Kery SAB II/vk 1/I √ √

76 391404 Ny.Siti Munawaroh 21th √ Umum Excisi tu mamae dr.Bambang TIVA III 2/III √ √

77 391575 Sdr.M.Ali Fikri 34th √ Umum Herniotomy dr.Hernowo SAB II 3/III √ √

78 358329 Ny.Umiyatun 43th √ Umum Excisi mamae abram dr.Bambang TIVA III 2/III √ √

79 391972 Tn.Nur Ahmad 44th √ Umum Haemoroidectomy dr.Bambang SAB II 1/III √ √

80 390770 An.Alvin Ardiansyah 8th √ Umum Excisi ganglion dr.Bambang SAB II 1/II √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
81 184246 Ny.Reny Triana 37th √ Obgyn LSCS dr.Umi SAB III/vk 2/IV √

82 391491 Tn.Rahmad Heru 28th √ Umum 1/13/2017 Excisi multiple clavus dr.Sukarno SAB III 1/I √ √

83 392051 Ny.Sandra Retno P 23th √ Obgyn LSCS dr.Kery SAB II/vk 3/I √ √

84 332323 Ny.Binti Mahmudah 40th √ Obgyn LSCS+MOW dr.Umi SAB I 2/I √

85 387881 Ny.Hartini 51th √ Umum Excisi lipoma dr.Hernowo masker I 2/III √ √

86 392132 Ny.Rumiati 41th √ Obgyn SOS dr.Umi SAB III/vk 2/III √

87 347526 Sdr.Aris Fahrudi 23th √ Ortho Dbridement dr.Hari C masker III 4/I √ √

88 347526 Ny.Sucik Kusumawati 33th √ Obgyn 1/14/2017 LSCS+MOW dr.Kery SAB II/vk 3/I √ √

89 348166 Ny.Helga Fitria 26th √ Obgyn LSCS dr.Kery SAB II/vk 2/I √ √

90 390569 Tn.Misdiyanto 37th √ Umum Herniotomy dr.Hernowo SAB II 1/I √ √

91 386207 Ny.Sumarni 32th √ Obgyn LSCS dr.Umi SAB II/vk 3/II √ √

92 386687 Ny.Endang Retnowati 35th √ Obgyn LSCS+insersi IUD dr.Umi SAB II/vk 2/II √ √

93 386315 Ny.Chandra 28th √ Obgyn LSCS dr.Umi SAB I/vk 3/III √ √

94 392278 Tn.M.Ary Teguh 30th √ Ortho 1/15/2014 Debridement+pining dr.Danang intubasi II 4/I √

95 390834 Ny.Subahikah 62th √ Umum Exterpasi tu occipital dr.Sukarno intubasi II 2/I √ √

96 289959 Ny.Lutfiani 31th √ Obgyn LSCS dr.Umi SAB II/vk 3/I √ √

97 299472 Sdr.Medianto P 28th √ Umum Debridement+pining dr.Sukarno masker II 1/I √

98 240591 Ny.Rahma Andiya 40th √ Umum Excisi fam dr.Hernowo masker II 2/II √ √

99 298740 Ny.Lilik Susiati 58th √ Umum Excisi clavus dr.Hernowo SAB II 2/II √ √

100 391557 Tn.Sutriyatno 58th √ Umum Exterpasi ateroma dr.Sukarno LA RJ 1/III √ √


KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
101 386945 Ny.Fatma 35th √ Obgyn 1/17/2017 LSCS + MOW dr.Kery SAB I/vk 3/I √ √ √

102 194155 Ny.Agus Ardiyati 32th √ Obgyn LSCS dr.Kery SAB III/vk 2/I √ √ √

103 3992207 Ny.Linda mariyana 35th √ Obgyn Couter dr.Kery SAB III/vk 1/II √ √

104 376473 Ny.Dzarotun 31th √ Obgyn LSCS+insersi IUD dr.Umi SAB II/vk 3/II √ √ √

105 391870 Ny.Rokhimatus S 31th √ Obgyn LSCS+insersi IUD dr.Heru B SAB II/vk 1/I √ √ √

106 389749 Ny.Linda Sulistyaningsih 42th √ Obgyn LSCS+insersi IUD dr.Umi SAB III/vk 2/II √ √ √

107 391659 Tn.Wahyu Tjatmiko 34th √ Umum Excisi lipoma dr.Hernowo TIVA II 1/II √ √ √

108 054445 Tn.M.Fajar Rizki 25th √ Urologi Sachce dr.Kristianto SAB II 2/III √ √ √

109 392466 Ny.Esliasitta 45th √ Umum 1/18/2017 Exterpasi cystosa phyloid dr.Sukarno intubasi II 4/I √ √ √

110 392501 Ny.Prita Dwi 34th √ Obgyn LSCS dr.Kery SAB II 3/I √ √ √

111 392460 Ny.Dwi Suriasih 26th √ Obgyn Curetage dr.Umi SAB II/vk 3/III √ √ √

112 078162 Ny.Irawati Dwi 40th √ Obgyn LSCS dr.Kery SAB II/vk 2/I √ √ √

113 392452 Ny.Rini Kusumawati 39th √ Obgyn SOS dr.Kery SAB II/vk 1/I √ √ √

114 392508 Ny.Khalimatus 20th √ Obgyn LSCS dr.Kery SAB II/vk 3/II √ √ √

115 392419 Ny.Lilik P 37th √ Obgyn Curetage dr.Kery SAB II/vk 2/III √ √ √

116 392227 Ny.Rhina Iswahyuni 35th √ Umum Incisi abces parotis dr.Hernowo LA RJ 1/II √ √

117 391762 Nn.Umi Aidania 13th √ Umum Excisi fam dr.Hernowo masker III 2/IV √ √ √

118 110252 Nn.Rani Ratna K 15th √ Umum Excisi fam dr.Hernowo masker II 3/IV √ √ √

119 392500 An.Salsabila Nur 10th √ Umum Excisi lipoma dr.Hernowo masker II 2/V √ √

120 392500 Nn.Lailatul Badriyah 22th √ Ortho Dedridement+pining dr.Danang intubasi III 4/I √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
121 344521 Ny.Nasiatur R 35th √ Obgyn 1/19/2017 SVH+SOD dr.Kery SAB II/VK 2/I √ √ √

122 392496 An.M.Mas'ud 9th √ Umum Appendictomy dr.Hernowo SAB VIPA 2/III √ √ √

123 371592 Ny.Hj.Siti Aisyah 6oth √ Umum Incisi+debridement dr.Hernowo SAB II 1/I √ √ √

124 391052 Tn.Yunianto 34th √ Urologi Excisi tu penis dr.Kristianto SAB II 3/II √ √ √

125 391866 Ny.Jauharsari W 29th √ Obgyn LSCS dr.Haris SAB III/VK 2/II √ √ √

126 392048 Ny.Nur Wahyun 33th √ Obgyn LSCS dr.Umi SAB II/VK 3/III √ √ √

127 392625 Nn.Agiata Wahyu 18th √ Umum Excisi clavus dr.Sukarno LA RJ 1/II √ √ √

128 319378 Ny.Siti Nur F 29th √ Obgyn LSCS dr.Umi SAB II 2/III √ √ √

129 392133 Nn.Cholifah Aulia 16th √ Umum 1/20/2017 Excisi fam dr.Bambang TIVA II 4/I √ √ √

130 390959 Nn.Devy Anindhika 22th √ Umum Excisi fam dr.Bambang TIVA II 2/I √ √ √

131 390392 Ny.Suhartatik 32th √ Umum Excisi fam dr.Bambang TIVA II 4/II √ √ √

132 391911 Ny.Acne Sania 28th √ Obgyn LSCS dr.Heru B SAB III/VK 1/I √ √ √

133 209934 Ny.Irmawati 27th √ Obgyn LSCS+insesrsi IUD dr.Umi SAB II/VK 3/I √ √ √

134 215798 Ny.Nur Diana 35th √ Umum Excisi lipoma dr.Hernowo masker VIPB 2/III √ √ √

135 392713 Ny.Lisa Rahmawati 34th √ Obgyn LSCS dr.Kery SAB II/VK 3/III √ √ √

136 392683 Ny.Ika Pristi W 25th √ Obgyn LSCS dr.Umi SAB II/VK 3/IV √ √ √

137 392677 Ny.Suntinah 39th √ Obgyn LSCS+MOW dr.Umi SAB II/VK 2/IV √ √ √
Laminectomy+stabilasasi
138 392612 An.Dio Arya S 13th √ Ortho posterior dr.Larona intubasi III 4/I √ √ √

139 380231 Ny.Khusnul U 38th √ Umum 1/21/2017 Exterpasi dermoid cyst dr.Sukarno masker II 2/I √ √ √

140 391728 Sdr.M.Muhyidin 15th √ Umum Appendictomy dr.Hernowo SAB II 1/I √ √ √


KETERANGAN : Sidoarjo, …………………………….
: UMUM EL: B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
141 392687 Sdr.A.Ariyanto 19th √ Umum Excisi tu punggung dr.Bambang masker III 2/II √ √

142 374727 Ny.Sulistyarini 34th √ Obgyn LSCS dr.Umi SAB II/VK 3/I √ √ √

143 330870 Ny.Harti 42th √ Obgyn LSCS+MOW dr.Umi SAB I/vk 3/II √ √ √

144 288671 Ny.Lilik Churotin 33th √ Obgyn LSCS dr.Umi SAB III/VK 2/I √ √ √

145 000814 Ny.Tri Hidayanti 18th √ Obgyn LSCS dr.Umi SAB III/VK 3/III √ √ √

146 389062 Ny.Rafika M 23th √ Obgyn LSCS dr.Kery SAB II/VK 2/IV √ √ √

147 392564 Ny.Febriana 25th √ Obgyn 1/23/2017 LSCS dr.Heru B SAB II/VK 3/I √ √ √

148 390821 Ny.Safira Alfira 15th √ Umum Lap.Appendiktomy dr.Sukarno SAB I 1/I √ √ √

149 363273 Ny.Rofiqoh 48th √ Umum Exterpasi papiloma dr.Sukarno SAB I 2/I √ √ √

150 170545 Ny.Ismi Indahyanti 36th √ Obgyn LSCS dr.Heru B SAB III/VK 3/II √ √ √

151 261783 Ny.Umi Masruroh 45th √ Umum Exterpasi Tumor dr.Bambang Masker II 1/I √ √ √

152 323393 An.M.Akhdan 2th √ Umum Herniotomy Repair Buli dr.Hernowo masker II 2/II √ √ √

153 391398 Ny.Asnur K 25th √ Umum Excisi Lipoma dr.Hernowo masker II 3/II √ √ √

154 392140 Ny.Ari Setya Wilujeng 28th √ Umum Excisi Fam dr.Bambang TIVA II I/II √ √ √
Laminectomy + Stabilisasi
155 392849 Tn.Awang Darmawa 33th √ Ortho Posterior dr.Larona Intubasi VVIPB 4/I √ √ √

156 392658 Ny.Maslukah 65th √ Obgyn Total vagina Histerecto dr.Umi SAB VIP A 3/II √ √ √

157 369229 Ny.Risalatul 24th √ Obgyn LSCS dr.Kery SAB II/VK 2/I √ √ √

158 391399 Ny.Indah S 29th √ Obgyn LSCS dr.Kery SAB III/VK 3/II √ √ √

159 258618 Ny.Wiwik Mardianah 42th √ Obgyn LSCS dr.Umi SAB I/VK 1/II √ √ √

160 258618 Ny.King Kinarti 50th √ Obgyn SVH + SOD dr.Kery SAB I/vk 2/III √ √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
161 332264 Ny.Widia astutik 28th √ Obgyn LSCS dr.Kery SAB II 3/I √ √ √

162 213822 Ny.Srianah 50th √ Umum Exterpasi Tumor dr.Sukarno SAB II 1/I √ √ √

163 388904 Tn.Buali 47th √ Bed.Syaraf Pasang VP Shunt dr.Fauzi Intubasi II 4/I √ √

164 272898 Nn.Emerentia P 16th √ Umum Appendiktomy dr.Hernowo SAB III 1/III √ √

165 370266 Tn.Toekijo 70th √ Urologi TUR / Vesicolithomy dr.Kristianto SAB II 2/IV √ √ √

166 392634 Ny.Siti Aisyah 27th √ Umum 1/25/2017 Excisi Fam dr.Sukarno Masker II 4/I √ √ √

167 389987 Ny.Eni Sofiah 37th √ Obgyn LSCS dr.Kery SAB II/VK 2/IV √ √ √

168 345704 Ny.Zenny Juliasih 42th √ Obgyn LSCS dr.Kery SAB II/VK 3/I √ √ √

169 368107 Ny.Afita Lusiana 27th √ Obgyn LSCS dr.Kery SAB II/VK 3/II √ √ √

170 390015 Ny.dewi Wulandari 34th √ Obgyn LSCS dr.Umi SAB II/VK 1/III √ √ √

171 392985 Ny.Anestesia 27th √ Obgyn LSCS dr.Kery SAB II/VK 2/II √ √ √

172 387667 Ny.Lina Madhasari 30th √ Obgyn LSCS + IUD dr.Umi SAB I/vk 1/I √ √ √

173 270240 Ny.Setia wati 42th √ Umum Excisi Tumor dr.Bambang Masker II 1/III √ √ √

174 389724 Ny.Rully Septika 29th √ Obgyn LSCS dr.Umi SAB I/vk 2/III √ √ √

175 391179 Ny.Sri widyawati 37th √ Obgyn 1/26/2017 SOS + Tubectomy D dr.Kery SAB II/VK 3/I √ √ √

176 375560 Ny.Hj.Aswati 62th √ Umum Excisi tumor dr.Bambang TIVA VVIPB 1/I √ √ √

177 393152 Ny.Chusnul Qotimah 29th √ Obgyn LSCS dr.Kery SAB II/VK 3/II √ √ √

178 392999 Tn.Didik K 39th √ Umum Herniotomy dr.Sukarno SAB II 2/I √ √ √

179 392368 Ny.Zulfa Mariani 42th √ Umum Sub total lobectomy dr.Sukarno Intubasi I 4/I √ √ √

180 199272 Tn.m.Yasin 68th √ Umum Excisi Lipoma dr.Hernowo Intubasi III 2/III √ √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
181 238640 Ny.Anik Churiyah 54th √ Umum Haemoroidektomy dr.Hernowo SAB II 1/II √ √ √

182 142710 Ny.Desie 40th √ Umum Cholecystectomy dr.Hernowo SAB II 2/III √ √ √

183 392149 Tn.Khoirul H 37th √ Urologi Vasoligasi tinggi palomo d dr.Kristianto SAB III 3/I √ √

184 210056 Ny.Nahum 36th √ Obgyn LSCS dr.Umi SAB II/VK 2/III √ √

185 320818 Ny.Dyah swati 29th √ Obgyn LSCS dr.Umi SAB III/VK 3/IV √ √

186 393190 Ny.Yatifah 56th √ Umum Exterpasi Clavus dr.Sukarno LA RJ 1/II √ √ √

187 117266 Ny.Suprapti 34th √ Obgyn 1/27/2017 LSCS + MOW dr.Kery SAB VVIPA 3/I √ √ √

188 371761 Ny.Sugiati 34th √ Obgyn LSCS dr.Kery SAB II/VK 3/II √ √ √

189 392379 Ny.Kurniasih 44th √ Umum Exterpasi Fam dr.Sukarno Masker II 4/I √ √ √

190 179006 Ny.Tri Kusuma Oktarina 30th √ Obgyn LSCS dr.Umi SAB I/VK 2/III √ √ √

191 369331 Ny.Lucky sandya 25th √ Obgyn LSCS + IUD dr.Umi SAB II/VK 2/III √ √ √

192 224340 Tn.Imam Haryanto 46th √ Umum Appendiktomy dr.Sukarno SAB II 1/I1/II √ √ √

193 339809 Ny.Ineke Kusuma 40th √ Obgyn Curetage dr.Kery SAB I/VK 3/III √ √ √

194 000370 Ny.dr.Muji R,SpA 45th √ Obgyn Curetage + Exterpasi dr.Kery SAB VIPA 2/III √ √ √

195 211214 Nn.Regine Alicia 17th √ Umum Excisi Fam dr.Bambang TIVA I 1/III √ √ √

196 391388 Nn.Lisa setyaning 16th √ Umum Excisi Fam dr.Bambang TIVA II 4/I √ √ √

197 391631 ny.Priyanti 41th √ Umum Subtotal Lobectomy dr.hernowo Intubasi III 3/III √ √ √

198 303327 Ny.Indra listi 27th √ Obgyn LSCS dr.Umi SAB I/VK 2/II √ √ √

199 393193 Ny.Rizki H 25th √ Obgyn LSCS dr.Umi SAB III/VK 3/I √ √ √

200 393334 Ny.Erik P 32th √ Obgyn 1/28/2017 LSCS dr.Kery SAB I/VK 2/I √ √ √
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI EL CY B BK K KTR U BPJS
201 393368 ny.Dian agustina 32th √ Obgyn 1/29/2017 LSCS dr.Umi SAB II/VK 3/I √ √ √

202 393367 Ny.Eviana Sari 24th √ Obgyn LSCS dr.Umi SAB II/VK 2/I √ √ √

203 391876 Ny.Anis Marliana 30th √ Obgyn 1/30/2017 LSCS dr.Kery SAB II/VK 3/I √ √ √

204 391297 Ny.Asizah kurnia 25th √ Obgyn LSCS dr.Kery SAB I/VK 3/II √ √ √

205 252615 Sdr Eko budi 23th √ Umum Excisi tumor dr.Bambang Masker II 1/I √ √ √

206 284033 Ny.Kiptiyah 42th √ Umum Excisi Fam dr.Bambang Masker II 2/II √ √ √

207 391394 Tn.M.Syaiful Bahri 43th √ Umum Excisi Tumor dr.Bambang Masker I 2/I √ √ √

208 391748 Ny.deniar Meyta P 31th √ Obgyn LSCS dr.Umi SAB II/VK 3/III √ √ √

209 393426 Ny.tri rohmawati 27th √ Obgyn LSCS dr.Umi SAB III/VK 2/III √ √ √

210 278416 Ny.Nur Laili 31th √ Obgyn Myomectomy dr.Umi SAB II/VK 3/III √ √ √

211 393505 Ny.Widya hestika 19th √ Obgyn 31/01/201 LSCS dr.Umi SAB II/VK 4/I √ √ √

212 393322 Ny.Sulih 77th √ Umum Debridement dr.Sukarno SAB VIPA 1/I √ √ √

213 380685 Ny.Sumiani 37th √ Obgyn LSCS dr.Umi SAB III/VK 3/I √ √ √

214 390902 Ny.Dewi fatimatul 40th √ Obgyn LSCS + MOW dr.Umi SAB III/VK 2/II √ √ √

215 350375 An.a.Alawy 2th √ Umum Exterpasi dermoid Cyste dr.Sukarno Masker II 2/I √ √ √

216 393532 Ny.Robiatul 26th √ Obgyn LSCS dr.Kery SAB II 3/II √ √ √

217 392527 An.Dea nabila 13th √ Umum Excisi Biopsi tumor dr.Hernowo Intubasi I 2/IV √ √ √

218 233188 An.Cecilia 6th √ Umum Excisi ganglion dr.Hernowo Masker II 2/III √ √ √

219 391855 Ny.Suherni 57th √ Ortho Aff Plate tibia dr.Danang SAB II 4/II √ √ √
220
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI EL CY B BK K KTR U BPJS
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI EL CY B BK K KTR U BPJS
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI EL CY B BK K KTR U BPJS
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI EL CY B BK K KTR U BPJS
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS JDWL OP KAT. LUKA OP BIAYA
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI EL CY B BK K KTR U BPJS
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN : Sidoarjo, …………………………….
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR Kaur Kamar Operasi
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI Agus Wiyono
OARJO

WAKTU OPERASI
BIAYA

As. sign in time out sign out selesai op

09.00 09.15 09.50 10.00

08.15 08.30 08.50 09.00

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

RBH

COB COMFEED

RBH

COB YAMAHA

IN HEALTH

Sidoarjo, …………………………….
OARJO

BIAYA

As.

jai

admed

japfa

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

RBH

Sidoarjo, …………………………….
OARJO

BIAYA

As.

JCI COB

CAR

Sidoarjo, …………………………….
OARJO

BIAYA

As.

COB

COB

ADMEDIKA

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
OARJO

BIAYA

As.

Sidoarjo, …………………………….
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : FEBRUARI TAHUN 2017

11 357894 Ny.Dina eka k 39th √ Obgyn LSCS + IUD dr.Heru B SAB II/VK 1/I
79 394389 Ny.Melinda N 25th √ Obgyn LSCS dr.Heru B SAB I/VK 4/I
154 395464 Ny.Dewi Asri 26th √ Obgyn Curretage dr.Heru B SAB II/VK 1/I
157 335051 Ny.Ruth Sriwijayanti 29th √ Obgyn LSCS dr.Heru B SAB II/VK 4/I
162 271225 Ny.Ernawati 34th √ Obgyn LSCS+MOW dr.Heru B SAB VVIPA 3/I
176 272014 Ny.Siti Muntadiroh 27th √ Obgyn LSCS dr.Heru B SAB II/VK 2/I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS OK
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP ronde
L P HESI
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JANUARI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
AN
SIDOARJO
7

√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO
016

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO
016

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO
016

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
AN
SIDOARJO
016

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MARET TAHUN 2017

90 002291 Ny.Nur JulaIkah 37th v Umum Ca mamae Modified radical mastectomy Ca mamae dr.Hernowo intubasi PAV 2/III

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL TGL DOKTER RWT
NO NO. REG NAMA PASIEN ANAST
KH B S K ISASI OPERASI POST OP OPERATOR INAP
L P HESI
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL TGL DOKTER RWT
NO NO. REG NAMA PASIEN ANAST
KH B S K ISASI OPERASI POST OP OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
HAN
SIDOARJO

v v v

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
HAN
SIDOARJO
2016

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 364256 Ny.Wahyuningsih 27th √ Obgyn 4/1/2017 G1P0A0 + Inpartu KIFA LSCS G1P0A0 + Inpartu KIFA dr.Umi SAB III/VK
2 394371 Tn.Ahmadi 44th √ Umum Tu.Coli D Excisi Tu.Coli D dr.Bambang Masker II
3 398372 Tn.Abd.Muclis 24th √ Umum Granuloma Umbilicus Excisi Granuloma Umbilicus dr.Bambang TIVA II
4 397951 Ny.Nadiya Nur C 19th √ Umum FAM Excisi FAM S dr.Hernowo Masker II
5 397389 Tn.Dimas Y 25th √ Umum Lipoma Punggung Excisi Lipoma Punggung dr.Hernowo Masker II
6 397601 ny.Nur Aini 36th √ Obgyn G3P1-1A1 + BSC LSCS G3P1-1A1 + BSC dr.Umi SAB III/VK
7 398148 Ny.Zulaihah 33th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.umi SAB III/VK
8 252200 Ny.Ratna Dewi 28th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
9 395877 Ny.Sundari 31th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB III/VK
10 248318 Ny.Arilia 31th √ Obgyn G2P1-1 + BSC LSCS+MOW G2P1-1 + BSC dr.Umi SAB I/VK
11 317979 Ny.Mega selvia 36th √ Obgyn 4/2/2017 G5P4-4 + BSC LSCS G5P4-4 + BSC dr.Umi SAB III/VK
12 350514 Ny.Hijrah Purnama 36th √ Obgyn G6P3-3A2 + PP Totalis LSCS G6P3-3A2 + PP Totalis dr.Umi SAB I/VK
13 242281 Ny.Sri Suhartini 37th √ Obgyn 4/3/2017 G3P2-2 + BSC LSCS G3P2-2 + BSC dr.Kery SAB II/VK
14 398515 Ny.Lutfi 28th √ Obgyn G2P1-1 + CPD LSCS G2P1-1 + CPD dr.Kery SAB II/VK
15 398699 Ny.Margaretha 26th √ Obgyn G1P0-0 + Haemmoroid LSCS G1P0-0 + Haemmoroid dr.Kery SAB I/VK
16 398700 Ny.Nur Hasanah 33th √ Obgyn G2P1-1 + PP LSCS G2P1-1 + PP dr.Kery SAB II/VK
17 396645 Tn.Sarojin 57th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III
18 398184 Ny.Yamini 46th √ Umum Lipoma Punggung Excisi Lipoma Punggung dr.Hernowo Masker III
19 270383 Ny.Zestika Yana 43th √ Umum Atheroma punggung Excisi Atheroma punggung dr.Hernowo TIVA II

20 387836 Ny.Erlin Istiyanti 23th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 398676 Sdr.M.Arif Wahyu 21th √ Ortho 03/04/2017 Fr.humerus Orif plating Fr.humerus dr.Hari C intubasi II/TC
22 291993 Ny.Kiki Anggraeni 22th √ Obgyn G1P0 ATH+PP LSCS G1P0 ATH+PP dr.Kery SAB II/VK
23 398701 Ny.Yeni Septiani 26th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK
24 295116 Ny.Kartini 38th √ Obgyn G3P2 ATH+PRM LSCS G3P2 ATH+PRM dr.Umi SAB III/VK
25 228032 Ny.Lilik N 31th √ Obgyn G2P1 ATH+nst non reaktif LSCS G2P1 ATH+nst non reaktif dr.Umi SAB II/VK
26 396351 Ny.Emy Agustina 33th √ Obgyn G2P1 ATH+gemelli LSCS G2P1 ATH+gemelli dr.Umi SAB II/VK
27 398242 Ny.Ayu Rahayu 27th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Umi SAB II/VK
28 396831 Ny.Yunita Affriana 29th √ Obgyn G1PO ATH+PEB LSCS G1PO ATH+PEB dr.Umi SAB II/VK
29 303343 Ny.Nur Istiqomah 38th √ Obgyn G3P2 ATH+BSC LSCS G3P2 ATH+BSC dr.Umi SAB II/VK
30 397276 Ny.Dwi Setyowati 33th √ Obgyn 04/04/2017 Mioma uteri SOD Mioma uteri dr.Umi SAB VVIPA
31 398546 Ny.Erna Dewi 31th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Heru B SAB II/VK
32 351097 Ny.Erti Kusumarini 40th √ Obgyn G4P2 ATH+gemelli LSCS+MOW G4P2 ATH+gemelli dr.Umi SAB III/VK
33 262335 Ny.Evi Kumalasari 28th √ Umum Appendik akut Appendictomy Appendik akut dr.Sukarno SAB I
34 397564 Ny.Juwati 46th √ Obgyn Mioma uteri TAH+BSO Mioma uteri dr.Kery SAB III/VK
35 218712 Ny.Yenita H 36th √ Obgyn G3P2 ATH+BSC LSCS+MOW G3P2 ATH+BSC dr.Kery SAB II/VK
36 398775 Ny.Titik Nadifah 33th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Umi SAB II/VK
37 381965 Tn.Sularno 43th √ Umum Fistel perianal Fistulectomy Fistel perianal dr.Hernowo SAB II
38 030008 Ny.Suryani 51th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB I/VK
39 398784 An.Fajar Syafani 15th √ Ortho Fr.radius D Orif plating Fr.radius D dr.Hari C intubasi II/TC
40 398784 Ny.Suharti 71th √ Ortho Fr.radius S Reposisi Fr.radius S dr.Hari C TIVA I/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
√ SAB+TI
41 378287 Tn.Edi Suroso 40th Ortho 04/04/2017 Post fr.patela+clavicula Aff plate Post fr.patela+clavicula dr.Hari C VA
II/TC
42 250071 Ny.Siti Mulyani 41th √ Urologi Batu phylum Pyelolithotomy D Batu phylum dr.Kristianto intubasi I
43 380223 Ny.Tutuk Purwati 28th √ Obgyn 05/04/2017 G1P0 ATH+CPD LSCS G1P0 ATH+CPD dr.Umi SAB II/VK
44 398917 Ny.Rina Mayasari 30th √ Obgyn G1P0 ATH+PP LSCS G1P0 ATH+PP dr.Kery SAB II/VK
45 355271 Ny.Khoiriyah 36th √ Umum Ulcus pedis D Wide excisi Ulcus pedis D dr.Sukarno SAB II
46 379022 Ny.Nur Khasanah 48th √ Obgyn Post op cyste+ILO Debridement+reheacting Post op cyste+ILO dr.Kery SAB III/VK
47 210718 An.Arya Sena 13th √ Ortho Cl.fr radius 1/3 tengah Orif plating Cl.fr radius 1/3 tengah dr.Danang masker PAV
Bedah
48 185985 Ny.Umi Khauwa 54th √ plastik Combutio 10% Debridement Combutio 10% dr.Ariek TIVA I
49 346367 Ny.Nikmatus S 33th √ Obgyn G4P2 ATH+gemelli LSCS G4P2 ATH+gemelli dr.Umi SAB II/VK
50 396533 Sdr.Agung W 24th √ Urologi Varicocel D Vasoligasi tinggi palomo D Varicocel D dr.Kristianto SAB II
51 396168 Nn.Endriani C 20th √ Umum Fam D Excisi Fam D dr.Hernowo masker II
52 398945 Ny.Rike Anggela 30th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK
53 176643 Ny.Syukrillah 34th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Umi SAB II/VK
54 398514 Ny.Siti Sahrul M 23th √ Obgyn 06/04/2017 G1P0 ATH+letsu LSCS G1P0 ATH+letsu dr.Kery SAB II/VK
55 251064 Ny.Kiki Resti 23th √ Obgyn Cistoma Ovarii D SOD Cistoma Ovarii D dr.Kery SAB II/VK
56 398908 Ny.Suanisah 33th √ Obgyn G3P0 ATH+PRM LSCS G3P0 ATH+PRM dr.Kery SAB II/VK
57 361195 Ny.Six Maylan S 23th √ Obgyn G1P0 ATH+PRM LSCS G1P0 ATH+PRM dr.Kery SAB II/VK
58 391255 Ny.Lusi Ermawati 29th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Kery SAB II/VK
59 213029 Ny.Hatmini W 47th √ Ortho Fr.fibula post plating Aff plate Fr.fibula post plating dr.Danang SAB II
60 036735 Tn.Irfandi 53th √ Umum HIL D+S Herniotomy HIL D+S dr.Hernowo SAB PAV
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 396817 Ny.Suci K 45th √ Umum 06/04/2017 Tu femur Excisi Tu femur dr.Bambang SAB II/TC
62 333763 Ny.Jari Murtini 40th √ Umum Tu pedis Excisi Tu pedis dr.Bambang SAB II/TC
63 320861 Tn.Ismanul 39th √ Urologi Strectur uretra Sache Strectur uretra dr.Kristianto SAB II
64 399096 Ny. Anita sari 30th √ obgyn G1P0-0+CPD LSCS G1P0-0+CPD dr.Umi SAB II/VK
65 394907 Ny.Nurida 37th √ obgyn 4/7/2017 G3P2-2 +BSC LSCS+MOW G3P2-2 +BSC dr.Heru B SAB II/VK
66 211386 Ny.Mela sofita 27th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Heru B SAB III/VK
67 398341 Ny.Rina isnanik 30th √ obgyn G2-P1-1 plase previa LSCS G2-P1-1 plase previa dr.Kery SAB III/VK
68 389344 Ny.Emma rulin S 32th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Umi SAB II/VK
69 397695 Ny.Eka lilis arini 31th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Kery SAB I/VK
70 398898 An.M.Syaifudin 12th √ ortho CF.FR Radius ulna Rposisi psng.Gips CF.FR Radius ulna dr.Danang Tiva I/TC
71 385368 Ny.Luluk Azizah 40th √ obgyn G4P3-2+BSC LSCS G4P3-2+BSC dr.Heru B SAB II/VK
72 396622 Ny.Sri yuliati 35th √ obgyn G3P2-1+BSC 2kali LSCS G3P2-1+BSC 2kali dr.Kery SAB II/VK
73 233983 Ny.Novita lidya 33th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Umi SAB II/VK
74 397332 Tn. M. Amin 44th √ umum Herniotomy Hil Dextra Herniotomy dr.Sukarno SAB II
75 396715 Ny.Anzi Vionetta 20th √ obgyn G1P0-0+Gemeli LSCS G1P0-0+Gemeli dr.Umi SAB II/VK
76 392983 Ny. Nur rohma 32th √ obgyn G4P2-2A1+PEB LSCS G4P2-2A1+PEB dr.UMI SAB II/VK
77 399192 Ny.Warsini 27th √ obgyn G1P0-0+PEB LSCS G1P0-0+PEB dr.Umi SAB II/VK
78 287853 Ny. Aprilia mulyawati 28th √ obgyn 08/04/2017 G3P1-1 +BSC LSCS G3P1-1 +BSC dr.Kery SAB II/VK
79 227584 Ny.Eny rahayu 31th √ obgyn G2P0-0+Plas.previa LSCS G2P0-0+Plas.previa dr.Kery SAB I/VK
80 399159 Ny.Titin sugiyarti 44th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 398212 Ny.Susilowati 47th √ umum Fam D Exterpasi Fam D dr.Sukarno Masker I
82 392962 Ny.Fitri Ningsih 41th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr. Heru SAB II/VK
83 398855 Ny.Siti Rohani 47th √ umum Abces Leher +DM Incisi Abces Leher +DM dr.Sukarno Tiva II
84 397468 Ny.Nikmatus S 28th √ obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Umi SAB II/VK
85 397801 Tn.Iswiyanto 57th √ umum Basiloma Incisi Basiloma dr.Bambang Masker III
86 399223 Ny.Anita Setiadewi 32th √ obgyn G2P1-1+Plase.previa LSCS G2P1-1+Plase.previa dr.Kery SAB II/VK
87 224043 Ny.Zonna arraga 26th √ obgyn G2P1-1 +BSC LSCS G2P1-1 +BSC dr.Umi SAB II/VK
88 Ny.Khusniah √ obgyn dr. Kery SAB II/VK
89 261282 Ny.Dwi wahyucahya 25th √ obgyn G2P1-1A0+BSC LSCS G2P1-1A0+BSC dr.Umi SAB II/VK
90 396844 Ny.Neona nur 26th √ obgyn G2P0-A1+LETSU LSCS G2P0-A1+LETSU dr.Umi SAB II/VK
91 399026 Tn.Sapari 78th √ umum HIL Incarserata Laparatomi,herniotomy HIL Incarserata dr.Hernowo Intubasi VIPA
92 399219 Tn.Nur kholis 36th √ umum Combutio Debridement Combutio dr.Hernowo Masker VIPA
Reposisi
93 399099 An.Aidam Raqqi 10bl √ umum Invaginasi ileum+appendictomy Invaginasi dr.Hernowo Intubasi VVIPB
94 399237 Nn.Nita Indah 21th √ umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB III
95 234621 Ny.Anastasiah 29th √ obgyn 09/04/2017 KET Salpngectomy S Ruptur tuba pars ampularis S dr.Umi SAB II/VK
96 383346 Ny.Oky Fitriah 25th √ obgyn 10/04/2017 G1P0 ATH+haemoroid LSCS G1P0 ATH+haemoroid dr.Kery SAB II/VK
97 312977 Ny.Mila Safitri 38th √ obgyn G4P1 ATH+BSC LSCS G4P1 ATH+BSC dr.Kery SAB II/VK
98 349594 Ny.Ernawati 37th √ obgyn Mioma uteri Miomectomy Mioma uteri dr.Kery SAB II/VK
99 399324 Ny.Uswatun K 36th √ obgyn Bartolini abses labia mayora Incisi Bartolini abses labia mayora dr.Kery SAB III/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
100 399309 Tn.Muslikh 38th √ Umum Haemoroid Haemoridectomy Haemoroid dr.Sukarno SAB III
101 398996 Ny.Tenty Kusworo 32th √ Umum Ca mamae Mastectomy Ca mamae dr.Bambang intubasi III
102 078920 Ny.Heny Candrasari 40th √ Umum Hemangioma skull Excisi Hemangioma skull dr.Hernowo LA RJ
103 398930 Tn.Widodo 44th √ Umum Multiple lipoma Excisi Multiple lipoma dr.Hernowo masker II
104 312335 An.Raditya 4th √ Umum Hidrocell D Hidrocelectomy Hidrocell D dr.Hernowo masker I
105 314586 Ny.Sulikah 47th √ Ortho Carpal tunel sindrom D Release tendon Carpal tunel sindrom D dr.Danang masker II
106 379702 Ny.Aulia Rahmawati 30th √ Obgyn G2P1 ATH+riw vacum LSCS G2P1 ATH+riw vacum dr.Kery SAB VVIPA
107 396985 Ny.Puput Mustika 26th √ Obgyn G3P2 ATH+BSC LSCS G3P2 ATH+BSC dr.Kery SAB II/VK
108 399360 Ny.Indrawati 35th √ Obgyn 11/04/2017 G4P2 ATH+PRM LSCS G4P2 ATH+PRM dr.Kery SAB III/VK
109 399460 Ny.Della A 22th √ Obgyn G1P0 ATH+PP LSCS G1P0 ATH+PP dr.Kery SAB III/VK
110 208128 Ny.Indah Immatus 29th √ Obgyn G2P1 ATH+gemelli LSCS G2P1 ATH+gemelli dr.Kery SAB II/VK
111 383518 Ny.Berlia Yuliana 24th √ Obgyn G1P0 ATH+letsu LSCS G1P0 ATH+letsu dr.Kery SAB II/VK
112 398449 Ny.Gestiani K 37th √ Obgyn Cistoma ovarii S SVH+SOS Cistoma ovarii+mioma uteri dr.Kery SAB II/VK
113 387531 Ny.Niaseh 56th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Bambang SAB I
114 241441 Ny.Dhiane 33th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB I/V
115 394144 Tn.Tjio W 54th √ Urologi Suspect ca buli Sistoscopy Suspect ca buli dr.Kristianto SAB VVIPB
116 399536 Ny.Tri Lusiani 33th √ Obgyn 12/04/2017 G2P1 ATH+oligohidramnion LSCS G2P1 ATH+oligohidramnion dr.Heru B SAB III/VK
117 397361 Ny.Siti Hanimah 26th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK
118 389713 Ny.Euis Maisaroh 34th √ Obgyn G3P2 ATH+BSC LSCS+MOW G3P2 ATH+BSC dr.Kery SAB I/VK
119 399570 Ny.Dian Lestari 26th √ Obgyn G1P0 ATH+PRM LSCS G1P0 ATH+PRM dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI

120 197602 Ny.Halilah Nur 38th √ Obgyn 12/04/2017 G3P2 ATH+BSC LSCS G3P2 ATH+BSC dr.Kery SAB III/VK

121 399447 Tn.Sutopo M 40th √ Umum Absas cruris Multiple incisi+debridement Absas cruris dr.Hernowo SAB I

122 333313 Ny.Setiawan 58th √ Umum Tu manus Excisi Tu manus dr.Hernowo masker I

123 398333 Tn.Suyoto 63th √ Umum HIL S Herniotomy HIL S dr.Bambang SAB II

124 399385 Tn.Agus Triswandi 44th √ Ortho Cl fr radius distal Reposisi Cl fr radius distal dr.Danang TIVA II

125 398159 Ny.Tatik Kadarini 36th √ Obgyn G3PI ATH+BSC LSCS G3PI ATH+BSC dr.Kery SAB II/VK

126 387193 Ny.Ismawati 23th √ Obgyn G1P0 ATH+PP LSCS G1P0 ATH+PP dr.Kery SAB II/VK

127 396420 Ny.Inggrit M 38th √ Obgyn 13/04/2017 G1P0 ATH+letsu LSCS G1P0 ATH+letsu dr.Kery SAB II/VK
128 390003 Ny.Indriyani 35th √ Obgyn G2PI+gemelli IUFD LSCS G2PI+gemelli IUFD dr.Kery SAB II/VK

129 303760 Ny.Dhian Pratama 29th √ Obgyn G3P1 ATH+cistoma ov LSCS G3P1 ATH+cistoma ov dr.Kery SAB II/VK

130 336763 Ny.Rien Latakuria 25th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK

131 317008 Tn.Laurntius G 59th √ Obgyn HIL residif Herniotomy HIL residif dr.Bambang SAB II

132 399592 Tn.Junaedi 50th √ Umum Ganglion poplitea Excisi Ganglion poplitea dr.Bambang SAB II/TC

133 399701 Sdr.Lingga Gusti 15th √ Ortho Cl fr.radius ulna distal Refraksi gips Cl fr.radius ulna distal dr.Danang TIVA PAV

134 349018 Ny.Fauziyah 28th √ Obgyn G3P2 ATH+PP LSCS G3P2 ATH+PP dr.Kery SAB I/VK

135 313800 Ny.Mufidzatuz 43th √ Umum Appendicitis Appendictomy Appendicitis dr.Bambang SAB III

136 336871 Ny.Ragil Dwi S 25th √ Obgyn G1P0 ATH+CPD LSCS G1P0 ATH+CPD dr.Heru B SAB II/VK

137 269585 Ny.Dewi Yunita 33th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Umi SAB II/VK

138 399788 Ny.Yuliana 39th √ Obgyn G2P1 ATH+APB LSCS G2P1 ATH+APB dr.Umi SAB III/VK
139 399669 Tn.Ahmad 60th √ Bedah syarf COS pariental Trepanasi COS pariental dr.Fauzi intubasi II

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
140 324326 Ny.Sri Wahyuni 38th √ Obgyn G2P1 ATH+BSC LSCS+insersi IUD G2P1 ATH+BSC dr.Umi SAB I/VK
141 366107 Ny.Indana Ayu 25th √ Obgyn G4P1 ATH+prolong aktif LSCS G4P1 ATH+prolong aktif dr.Umi SAB II/VK
142 393531 Ny.Ardila Windra 32th √ Obgyn G1P0 ATH+PRM LSCS G1P0 ATH+PRM dr.Umi SAB I/VK
143 394203 Ny.Maria Shisilia 29th √ Obgyn 15/04/2017 G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK
144 399603 Ny.Hanim Faridah 52th √ Ortho Cl fr coleus Reposisi Cl fr coleus dr.Danang masker II
145 135204 Ny.Prima Sari 35th √ Obgyn G3P2 ATH+BSC LSCS+MOW G3P2 ATH+BSC dr.Kery SAB I/VK
146 208196 Tn.Yuniar F 36th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Sukarno SAB II
147 399401 Nn.Diah Maulina 26th √ Umum FAM Excisi FAM dr.Hernowo masker II
148 399500 Nn.Mei Elfasari 24th √ Umum FAM Excisi FAM dr.Hernowo masker II
149 378318 Ny.Sumiati 47th √ Umum Abses cruris Incisi+debridement Abses cruris dr.Hernowo SAB VVIPB
150 387272 An.M.Pandu R 9bln √ Urologi Phymosis Sircumsisi Phymosis dr.Kristianto masker II
151 399908 Latifatul M 28th √ Obgyn G1Po-o + Featal distress LSCS G1Po-o + Featal distress dr.Kery SAB III/Vk
152 394586 Ny.Nita Rachmawati 28th √ Obgyn 4/16/2017 G3P2-2 + bsc 2x LSCS G3P2-2 + bsc 2x dr.Umi SAB II/VK
153 399938 Ny.Rumini 34th √ Obgyn G2P1-1 + PRM LSCS G2P1-1 + PRM dr.Umi SAB III/Vk
154 316646 Ny.Sudrotul F 34th √ Obgyn G3P1-1A1 + PEB LSCS G3P1-1A1 + PEB dr.Kery SAB II/VK
155 399494 Tn.Hairul Rasyid 39th √ Umum 17/04/2017 Lipoma axilla Exterpasi Lipoma axilla dr.Sukarno masker II
156 399487 Tn.Djain 68th √ Umum Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno TIVA II
157 202573 Ny.Nurma Yunita 34th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Heru B SAB II/VK
158 262836 Ny.Lestari Nur H 33th √ Obgyn G4P3 ATH+BSC LSCS G4P3 ATH+BSC dr.Heru B SAB I/VK
159 399613 Ny.Siti Kumala 53th √ Umum Tu colli Excisi Tu colli dr.Bambang masker II
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
160 399132 Ny.Anik Indriyana 34th √ Umum Mamae abrant Excisi Mamae abrant dr.Bambang masker II
161 335834 Ny.Ida Srimaida 47th √ Ortho Tendovaginitis Release tendon Tendovaginitis dr.Danang masker II
162 400041 Ny.Putri Ragil H 16th √ Obgyn G1P0 ATH+KIFL LSCS G1P0 ATH+KIFL dr.Umi SAB III/VK
163 309774 Ny.Yeni Ariani 32th √ Obgyn G3P1 ATH+BSC LSCS G3P1 ATH+BSC dr.Umi SAB III/VK
164 400062 Ny.Dian A 34th √ Obgyn G3P2 ATH+KIFL LSCS+MOW G3P2 ATH+KIFL dr.Umi SAB II/VK
165 399426 Tn.Sugiyo 68th √ Umum 18/04/2017 HIL duplex Herniotomy HIL duplex dr.Sukarno SAB II/TC
166 000951 Ny.Lutfiah 42th √ Obgyn Cistoma ovarii SOS Cistoma ovarii dr.Kery SAB II/VK
167 399623 Ny.Siti Fatimah 25th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Heru B SAB III/VK
168 336314 Ny.Triastin Noer 24th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Umi SAB II/VK
169 399615 Tn.M.Syukron A 31th √ Umum Lipoma leher+tangan Excisi Lipoma leher+tangan dr.Bambang TIVA II
170 271439 Tn.Gunawan S 41th √ Umum Abses perianal Incisi Abses perianal dr.Hernowo SAB II/TC
171 399586 Ny.Ageta Febria 34th √ Umum Mamae abrant Excisi Mamae abrant dr.Bambang masker III
172 352800 Ny.Suprapti 33th √ Obgyn G3P2 ATH+BSC LSCS G3P2 ATH+BSC dr.Umi SAB II/VK
173 398143 Ny.Izza Aulia 30th √ Obgyn 19/04/2017 G2PI ATH+BSC LSCS G2PI ATH+BSC dr.Kery SAB II/VK
174 383484 Ny.Serly Adelin 26th √ Obgyn G2P0 ATH+letsu LSCS G1P0 ATH+letsu+PP dr.Kery SAB III/VK
175 246288 Tn.Didik Efendi 49th √ Umum HIL Herniotomy HIL dr.Sukarno SAB I
176 204690 Nn.Aisyah B 18th √ Umum Ductus thyroglusus ciste Excisi Ductus thyroglusus ciste dr.Sukarno intubasi I
177 400136 Ny.Isti Kurniati 22th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB III/VK
178 399116 Ny.Nunik Purwanti 40th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Kery SAB I/VK
179 398513 Ny.Tutuk Iswayarti 47th √ Umum FAM Excisi FAM dr.Hernowo masker I

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
180 398991 Tn.Imam Soleh 39th √ Umum Tu cruris Excisi Tu cruris dr.Bambang SAB II
181 328295 Ny.Ernanie 59th √ Ortho Tringger fingger digiti III Release tendon Tringger fingger digiti III dr.Danang masker III
182 395833 Ny.A'yunul F 27th √ Obgyn G2P0 ATH+BSC LSCS G2P0 ATH+BSC dr.Heru B SAB I/VK
Op fr phalang distal digiti I Op fr phalang distal digiti I
183 400177 Ny.Nuning Tri 41th √ Ortho manus S Debridement+pining manus S dr.Danang masker II
Buka
Post opfr tibia dg degloving jahitan+debridement+psg Post opfr tibia dg degloving
184 400158 Ny.Sunia Dewi 35th √ Ortho luas gips luas dr.Danang SAB II
185 399027 Ny.Yayuk Yuliati 34th √ Umum Struma multi nodusa Sub total tyroidectomy Struma multi nodusa dr.Hernowo intubasi II
186 396403 Ny.Luluk Atin 52th √ Umum Struma multi nodusa Sub total tyroidectomy Struma multi nodusa dr.Hernowo intubasi II
187 389263 Ny.Lisa Kumalasari 31th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Umi SAB II/VK
188 399883 Ny.Amelinda P 28th √ Obgyn Tu kulit di vulva Couter Tu kulit di vulva dr.Umi TIVA I/VK
189 399605 Tn.Hari Efendi 28th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
190 399722 Ny.Aminah 48th √ Umum 20/04/2017 Ganglion poplitea Excisi Ganglion poplitea dr.Sukarno SAB III
191 187705 Ny.Mita Nur D 27th √ Obgyn G4P1 ATH+BSC LSCS G4P1 ATH+BSC dr.Kery SAB II/VK
192 397586 Ny.Siti Anis K 24th √ Obgyn G3P2 ATH+haemoroid LSCS G3P2 ATH+haemoroid dr.Kery SAB II/VK
193 399839 Ny.Eli Yulfia 29th √ Obgyn G2PI ATH+haemoroid LSCS G2PI ATH+haemoroid dr.Kery SAB II/VK
194 399369 Ny.Erni W 22th √ Obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.Kery SAB II/VK
195 336376 Ny.Astutik 28th √ Obgyn G4P2 ATH+BSC LSCS G4P2 ATH+BSC dr.Heru B SAB II/VK
196 333863 Ny.Eva widayati 26th √ umum Apendicitis Apendictomy Apendicitis dr.hernowo SAB III
197 262341 Ny.Sumarni 59th √ Umum Ulcus pedis digiti 5 Amputasi +debridement Ulcus pedis digiti 5 dr.hernowo SAB I
198 400315 Ny.Navi Rohmania 28th √ obgyn G2P1 ATH+BSC LSCS G2P1 ATH+BSC dr.kery SAB II/VK
199 367100 Ny.Widya Anggraini 25th √ obgyn G1P0-0 PRM LSCS G1P0-0 PRM dr.umu SAB VVIPA
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
200 37118 An.Aqilla dwi A 1th √ umum GED +gagal infus Vena Sectie GED +gagal infus dr.Sukarno LA VVIPB
201 300075 Ny.Yeni rusmiati 37th √ obgyn Cystoma Ovarii Cystectomy Cystoma Ovarii dr.Umi SAB II/VK
202 322668 Ny.Yosti aridini 52th √ obgyn Cystoma Ovarii BSO + SVH + Appendiktomy Cystoma Ovarii dr.Umi SAB I/VK
203 400360 Ny.Dian lutfiyah 25th √ obgyn G1P00+oligo +PROM LSCS G1P00+oligo +PROM dr.Umi SAB III/VK
204 304445 Ny.Devia agustiana 30th √ obgyn 4/21/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB I/VK
205 399065 Ny.Umi salamah 47th √ umum FAM Excisi FAM dr.Sukarno MASKER III
206 296680 Ny.Neilla nurilla 26th √ obgyn G3P1-1 +BSC LSCS G3P1-1 +BSC dr.Kery SAB II/VK
207 400106 Ny.Ika wahyu 31th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
208 237296 NY.Nunik susilowati 37th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB III/VK
209 396156 NY.Dwi nurhidayah 26th √ obgyn G1P0A0 nst non reaktif LSCS G1P0A0 nst non reaktif dr.Umi SAB II/VK
210 399588 Ny.Hj. Mukti 54th √ umum Tumor sigmoid Sigmoidectomy Tumor sigmoid dr.Hernowo intubasi VVIPB
211 398954 Tn. Karmidi 51th √ umum Struma Total lobectomy Struma dr.Bambang intubasi II
212 387619 An.M.rara azka 1th √ umum HIL Herniotomy HIL dr.Bambang masker II
213 399238 Ny.Dewi andalusia 42th √ obgyn 22/04/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
214 52337 Ny.H J. asmaniyah 58th √ orho Carpal tunel syndrom D Release tendon Carpal tunel syndrom D dr.Danang masker VIP
215 398158 Ny.Eva lestyorini 30th √ obgyn G1P0A0 +PEB LSCS G1P0A0 +PEB dr.Kery SAB II/VK
216 397867 Ny. Henny undhari 39th √ obgyn G5P1A3+letsu LSCS G5P1A3+letsu dr.Kery SAB II/VK
217 178031 Ny.Choirul bariyah 40th √ orho Fr tibia D post plating Aff plate Fr tibia D post plating dr.Hari C SAB VIP
218 400455 Tn. M. Nurkholis 33th √ umum Peritonitis Laparatomy+appendictomy Peritonitis dr.Sukarno SAB III
219 400491 Ny.Ninik indayanti 26th √ obgyn G1P0A0+letsu LSCS G1P0A0+letsu dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
220 400408 Ny.Fitriyana 25th √ obgyn G1P0A0+CPD LSCS LSCS dr.Kery SAB II/VK
221 234290 Ny. Laili sabicha 32th √ obgyn G2P1A0+BSC LSCS LSCS dr.Kery SAB II/VK
222 358633 Ny.Pipit yuwarawati 37th √ obgyn G3P2A0+BSC LSCS+MOW LSCS+MOW dr.Umi SAB I/VK
223 399990 NY.Indah mayang 24th √ obgyn G2P1A0+BSC LSCS LSCS dr.Umi SAB II/VK
224 400526 Tn.Abdul Gofur 24th √ ortho Cross injuri digiti V manus S Debridement+heacting Debridement+heacting dr.Hari C masker II/TC
225 204998 Ny.Siti Aisyah 32th √ obgyn 24/04/2017 G2P2A0+BSC LSCS LSCS dr.Umi SAB VVIPA
226 398609 Ny.Shinta Dewi 34th √ obgyn G3P2A0+BSC LSCS LSCS dr.Umi SAB II/VK
227 390602 Ny.Lilik Mualifah 40th √ obgyn 25/04/2017 Mioma uteri SVH SVH dr.Kery SAB II/VK
228 382707 Ny.Khusnul F 32th √ obgyn G3P2A0+BSC LSCS LSCS dr.Heru B SAB II/VK
229 382800 Ny.Anggun F 27th √ obgyn G1P0A0+PEB LSCS LSCS dr.Umi SAB II/VK
230 349753 Ny.Dita Widya M 22th √ obgyn G2P1A0+BSC LSCS LSCS dr.Umi SAB I/VK
231 400691 Tn.Ricky S 28th √ ortho Cros injuri digiti V manus D Debridement+pining Debridement+pining dr.Hari C intubasi II/TC
232 393449 Ny.Riska Ningsih 24th √ obgyn 26/04/2017 G1P0A0+cistoma ovarii LSCS LSCS dr.Kery SAB II/VK
233 388643 Ny.Miftachul J 33th √ obgyn G5P4A0+thyroid LSCS+MOW LSCS+MOW dr.Kery SAB II/VK
234 397961 Ny.Siti Imrotin 33th √ obgyn G3P1A1+BSC LSCS LSCS dr.Kery SAB III/VK
235 165763 Ny.Dessy Ahadian 36th √ obgyn G4P2A1+BSC LSCS LSCS dr.Haris SAB I/VK
236 370141 Ny.Mutgiyanti 36th √ obgyn G5P2A3+BSC LSCS+MOW LSCS+MOW dr.Umi SAB III/VK
237 399409 Ny.Marinda Fauza 21th √ obgyn G1P0A0+letsu LSCS LSCS dr.Umi SAB II/VK
238 400503 Ny.Amirotul 21th √ obgyn G1P0A0+mal posisi LSCS LSCS dr.Umi SAB III/VK
239 400014 Ny.Siti Rodiyah 37th √ obgyn Cistoma ovarii Reheacting usus Perlengketan sigmoid dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
240 3195974 Sdr.Kukuh S 29th √ Ortho Soft tisue tu manus D Excisi Soft tisue tu manus D dr.Danang masker II/TC
√ Bedah
241 384590 nNy.Siti Sundari 38th plastik
Bone expose manus Excisi Bone expose manus dr.Ariek intubasi III
242 399047 Ny.Agista N 24th √ Obgyn 4/27/2017 G1P0A0+Haemoroid LSCS G1P0A0+Haemoroid dr.Kery SAB I/VK
243 400830 Ny.Lidia Budiarti 37th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB III/VK
244 400104 Ny.Yuni Riska N 31th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB III/VK
245 397175 Ny.Sulistiowati 33th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
246 400841 Ny.Drivani Diah P 26th √ Obgyn G1P0A0+post date LSCS G1P0A0+post date dr.Haris SAB II/VK
247 057151 Ny.Yustin F 31th √ Obgyn G7P3A3+letsu LSCS+MOW G7P3A3+letsu dr.Umi SAB II/VK
248 172146 Ny.Churin Ainun 35th √ Obgyn G2P1A0+hydramnion LSCS G2P1A0+hydramnion dr.Kery SAB I/VK
249 386352 Ny.Sri suryaningsih 33th √ Obgyn G1 P0-0 + CPD LSCS G1 P0-0 + CPD dr.umi SAB II/VK
250 299703 Ny.Awinda R 28th √ Obgyn G2P0-0A1 + KIFL LSCS G2P0-0A1 + KIFL dr.Kery SAB VVIP/VK

251 275946 Tn. H .Sulkan 70th √ Urologi BPH TUR BPH dr.Kristianto SAB I
252 383554 Ny.Yanti Kuswahyuni 34th √ Obgyn G2P1-1 + PP marginalis LSCS G2P1-1 + PP marginalis dr.Umi SAB II
253 326571 Ny.Oky Gladis 25th √ Obgyn G4P1-A2 + Placenta previa LSCS G4P1-A2 + Placenta previa dr.Umi SAB II/VK
254 400793 Ny.Nurul Fauza 29th √ Obgyn Abortus Incomplete Curetage Abortus Incomplete dr.Umi SAB II
255 400937 Ny.Liem imel 42th √ Obgyn 4/28/2017 Myoma Uteri SOD Cystoma Ovarii dr.Kery SAB I
256 400882 Ny.Khusniawati 28th √ Obgyn G2P1-1 + PEB LSCS LSCS dr.Haris SAB III
257 257400 An.Dimas putra 13th √ Umum Appendikcitis acut Laparatomy+Appendiktomy Laparatomy+Appendiktomy dr.hernowo SAB II
258 400289 Ny.Yuyun Lafitri 21th √ Obgyn G1P0-0 + PEB LSCS LSCS dr.kery SAB III
259 221651 Ny. Tri wijayanti 30th √ Obgyn G2P1-1 + High Myopi LSCS + IUD LSCS + IUD dr.umi SAB I
KETERANGAN :
401046 : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
400947 : BPJS CY: CYTO BK: BERSIH KONTAMINASI
297637 : ASURANSI K: KONTAMINASI
371209
400779
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR
HESI
INAP
L P
Debridement+wiring+heacti
260 000733 Sdr.Donivam 23th √ Ortho Open fr digiti manus D ng
Open fr digiti manus D dr.Hari C intubasi III/TC
Multiple vulnus appertum Multiple vulnus appertum
261 401011 nn.yulna ayu 22th √ Bedah plastik 4/29/2017 fascialis
Repair fascialis+femur fascialis+regloving femur dr.Ariek intubasi III
262 401046 Sdr.Syamsul Ma'arif 29th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
263 400947 Tn.m.Shokib 44th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
264 297637 ny.suminem 41th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II
265 371209 Nn.Devina Gabriela 16th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB I
266 400779 Ny.Fantim Astutik 25th √ Obgyn 4/30/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
267 401151 Ny.Widya Yunita 36th √ Obgyn G2P2A0+oligohidramnion LSCS G2P2A0+oligohidramnion dr.Kery SAB II/VK
268
269
270
271
272
273
274
275
276
277
278
279
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : APRIL TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
3/II √ √ Takaful

2/I √ √ √

2/II √ √ cob jci

3/II √ √ √

1/I √ √ √

4/II √ √ √

3/III √ √ √

3/V √ √ √
4/I √ √ √
3/III √ √ √

3/II √ √ √

3/I √ √ √

3/II v √ √

3/I v √ √
2/I v √ √

2/II v √ √

1/I v √ √

2/I √ √ √

2/II √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √

3/III √ √ √

2/III √ √ √

4/II √ √ √

3/IV √ √ √

2/V √ √ √
2/VI √ √ √

3/V √ √ √

3/VI √ √ √

2/I √ √ √

4/I √ √ √

3/III √ √ √

1/I √ √ √

2/II √ √ √

1/I √ √ KAI
3/II √ √ √

1/I √ √ √

3/IV √ √ √

IV/I √ √ √

1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
4/III √ √ √

2/I √ √ confed
3/I √ √ √

3/II √ √ √

1/I √ √ √

1/II √ √ √

4/I √ √ inhealth
3/II √ √ √

3/IV √ √ √

2/III √ √ √

2/II √ √ √

3/III √ √ √

2/IV √ √ √

3/II √ √ √
2/II √ √ √
2/I √ √ √
3/I √ √ √
3/III √ √ √

4/I √ √ √
2/III √ √ confeed
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/II √ √ √

4/III √ √ √

2/IV √ √ √

3/IV √ √ √

2/II √ √ √

2/I √ √ √

4/I √ √ √

3/III √ √ √

3/I √ √ √

4/II √ √ √

2/III √ √ √
3/II √ √ √

4/II √ √ √

1/I √ √ √

2/IV √ √ √

3/IV √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

2/II √ √ √

1/II √ √ √
3/III √ √ √

2/III √ √ √

3/III √ √ √

3/II √ √ √

2/II √ √ √

2/IV √ √ √

4/I √ √ √

1/II √ √ √

1/I √ √ √

2/V √ √ √

2/VI √ √ √

2/I √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

2/II √ √ √

1/IV √ √ √

2/IV √ √ √

1/II √ √ √

4/I √ √ √

3/III √ √ √

3/IV √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √ COB
1/I √ √ √

2.II √ √ √

2/II √ √ telkom

1/II √ √ √

2/III √ √ √
1/I √ √ √

2/I √ √ √

3/II √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ √

1/II √ √ √

2/III √ √ √

2/II √ √ √

4/I √ √ √

3/III √ √ √

2/IV √ √ √

3/I √ √ √
2/I √ √ √

3/II √ √ √

2/II √ √ √

2/III √ √ √

1/I √ √ √

4/I √ √ sampurna
3/II √ √ √

1/II √ √ √

3/IV √ √ √

3/V √ √ √

2/I √ √ √

4/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/II √ √ √

3/II √ √ √

3/I √ √ √

4/I √ √ √

2/I √ √ √

1/I √ √ √

2/I √ √ √

2/II √ √ √

1/II √ √ √

2/II √ √

2/III √ √ √

3/i √ √ √

2/I √ √ √

2/II √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

2/II √ √ √

2/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

4/I √ √ √

2/II √ √ √

3/II √ √ √

3/III √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

4/I √ √ √

2/II √ √ √

1/II √ √ √

4/I √ √ rbh
3/II √ √ √

2/I √ √ √

3/I √ √ jai
1/I √ √ √

1/II √ √ √

3/II √ √ √

2/III √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

4/I √ √ √

3/III √ √ √

4/II √ √ √
4/III √ √ √

2/V √ √ √

2/IV √ √ √

3/IV √ √ √

2/V √ √ √

1/II √ √ √

1/I √ √ √

3/I √ √ √

1/II √ √ √

3/II √ √ √

2/I √ √ √

2/III √ √ √ √
IN
HEALT
1/II √ √ H

1/III √ √ √

2/III √ √ √
JACIN
2/IV √ √ DO
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

3/I √ √ √

2/IV √ √ √

3/II √ √ JAI
3/I √ √ √

1/I √ √ √

2/I √ √ AP I
3/II √ √ √

3/III √ √ √

2/I √ √ √

1/I √ √ √

4/II √ √ √

4/I √ √ √

2/I √ √ √

4/I √ √ √

3/I √ √ √
3/II √ √ √

4/II √ √ AIA
1/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/III √ √ √

2/III √ √ √

3/III √ √ √

2/IV √ √ √

4/III √ √ bpjs ket.


2/II √ √ √

2/I √ √ √

3/I √ √ √

2/I √ √ √
2/II √ √ √

3/II √ √ √

4/I √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

1/I √ √ √

4/II √ √ √

1/II √ √ √

4/I √ √ √

2/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √
2/III √ √ √ √

3/III √ √ √

3/I √ √ √

2/II √ √ √

2/I √ √ √

4/I √ √ √

1/I √ √ √

3/II √ √ √

4/II √ √ √

1/II √ √ SIMAS

2/III √ √ √

3/I √ √ √

1/IV √ √ √

4/III √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/II √ √ √

3/III √ √ JAI
Sidoarjo, …………………………….
Kaur Kamar Operasi
Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA


Rond
e EL CY B BK K KTR U BPJS As.
4/I √ √ √

2/I √ √ √

2/II √ √ √

4/I √ √ √

1/I √ √ √

1/II √ √ √

2/I √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA


EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 401165 Ny.Dewi wulandari 29th √ Obgyn 01/05/2017 G1P0-0 KPP + Fetal Distsres LSCS + Myomectomy G1P0-0 KPP + Fetal Distsres dr.Heru B SAB II / VK
2 400193 Ny.Garnis fitria 23th √ Obgyn G2P1-1 KPP + BSC LSCS G2P1-1 KPP + BSC dr.Heru B SAB III/VK
3 398975 Ny.Erma Nur 24th √ Obgyn 02/05/2017 G3P2-2 + BSC LSCS G3P2-2 + BSC dr.Kery SAB II/VK
4 396941 sdr.M.Fuad 17th √ Umum Hil Herniotomy Hil dr.Sukarno SAB II
5 400599 Ny.Qomaria 30th √ Umum Hemmoroid gr IV Hemoroidectomy Hemmoroid gr IV dr.hernowo SAB II
6 400787 Ny.Warsilah 65th √ Umum Tu.Punggung Excisi Tu.Punggung dr.bambang TIVA I
7 325598 nn.Riska dewi 25th √ Umum Tu.Axilla Excisi Tu.Axilla dr.bambang TIVA II
8 400810 ny.Dwi wijayanti 24th √ Umum Appendikcitis Appendictomy Appendikcitis dr.Bambang SAB III/TC
9 252666 tn.Khamim 60th √ Umum Ulcus Pedis + DM Multiple Incisi + debridemen Ulcus Pedis + DM dr.hernowo SAB I
10 048876 Sdr.Dwi Rafianto 16th √ Umum Clavus Pedis Exterpasi Clavus Pedis dr.Sukarno SAB RJ
11 390607 Tn.Choirul Anam 42th √ Urologi Batu Phylum Phyelolitotomi Batu Phylum dr.kristianto intubasi I
12 256161 Ny.Viviana Bella 22th √ Obgyn 03/05/2017 G2P1-1 KIFL + BSC LSCS G2P1-1 KIFL + BSC dr.Heru B SAB I
13 315951 Ny.Uswatun 28th √ Obgyn G1P0-0 + Visus -5 LSCS G1P0-0 + Visus -5 dr.kery SAB II
14 401334 Ny.Nur sari rahayu 28th √ Obgyn G2P1-1 + Placenta Previa LSCS G2P1-1 + Placenta Previa dr.Kery SAB II
15 400321 Ny.Sholatah 54th √ Umum Fibro lipoma Inguinal Exterpasi Fibro lipoma Inguinal dr.Sukarno SAB III
16 400463 Ny.Dwi riwantini 32th √ Obgyn G4P1-1A2 + BSC LSCS G4P1-1A2 + BSC dr.umi SAB II
17 308690 Ny.Dina Fauziah 27th √ Obgyn G3P2-2 + BSC 2x LSCS G3P2-2 + BSC 2x dr.Kery SAB I
18 312841 Tn.Suisman 46th √ Ortho Union Fr.Calcaneus Aff Screw Union Fr.Calcaneus dr.danang SAB I
19 355607 Ny.Sulistyawati 30th √ Umum Tu.Pedis excisi Tu.Pedis dr.bambang SAB II

20 401389 Ny.Indri Choiro 38th √ Obgyn G3P2-2 + PEB LSCS + MOW G3P2-2 + PEB dr.Kery SAB I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
Oovarectomy partial
21 400055 Ny.Fita Agus S 36th √ Obgyn 03/5/2017 Cistoma ovarii D+cistectomy S
Cistoma ovarii coklat dr.Umi SAB I/VK
22 265111 Tn.I Nyoman S 52th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
23 248922 Ny.Novia Wiyanto 35th √ Obgyn 04/5/2017 G2P1A0+IUFD LSCS G2P1A0+IUFD dr.Umi SAB I/VK
24 396604 Ny.Yuliati 38th √ Obgyn G2P1A0+gemelli LSCS G2P1A0+gemelli dr.Kery SAB I/VK
25 399874 Ny.Ma'rifatul 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
26 401350 Ny.Safitri 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
27 364895 Ny.Indah A 29th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB I/VK
SOD+cistectomy
28 231754 Ny.Tatik Pujiati 45th √ Obgyn Cistoma ovarii S+miomectomy
Cistoma ovarii+mioma uteri dr.Kery SAB II/VK
29 401384 Nn.Anggita Sri P 15th √ Umum Ganglion carpi Excioisi Ganglion carpi dr.Bambang SAB II
30 252129 Tn.Agus Trisanto 66th √ Umum HIL Herniotomy HIL dr.Bambang SAB I
31 399982 Tn.Hadi Suwignyo 49th √ Umum Lipoma scapula Excioisi Lipoma scapula dr.Hernowo SAB II
32 238602 Ny.Diah A 37th √ Obgyn G4P2A1+let lintang LSCS+MOW G4P2A1+let lintang dr.Umi SAB II/VK
33 397406 Ny.Ulcentia 29th √ Obgyn G2P0A1+post term LSCS G2P0A1+post term dr.Umi SAB II/VK
√ G1P0A0+CPD+fetal
34 401493 Ny.Ratna Dwi R 26th Obgyn G1P0A0+CPD LSCS distress
dr.Umi SAB II/VK
35 400013 Ny.ArIe Noer A 37th √ Obgyn G2P1A0+BSC LSCS G4P2A1+letsu dr.Umi SAB II/VK
36 400447 Ny.Lelyana L 35th √ Obgyn 05/5/2017 G4P2A1+letsu LSCS HIL dr.Heru B SAB II/VK
37 401243 Tn.Suhud Eko 38th √ Umum HIL Herniotomy G2P1A0+post date dr.Sukarno SAB III
38 399855 Ny.Iin Yulia 30th √ Obgyn G2P1A0+post date LSCS G3P2A018/19mg+IUFD dr.Kery SAB II/VK
39 401450 Ny.Nurul Al F 38th √ Obgyn G3P2A018/19mg+IUFD LSCS G2P1A0+BSC+IUFD dr.Kery SAB III/VK
40 226537 Ny.Fitra Yunanik 28th √ Obgyn G2P1A0+BSC+IUFD LSCS G2P1A0+BSC+IUFD dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017
KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 218146 Ny.Khalimatus S 26th √ Obgyn 05/5/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
42 399725 Ny.Marlin Wanna 41th √ Umum Tu phalang manus D Exterpasi Sipde disorder dr.Sukarno masker II
43 401525 Ny.Elly A 23th √ Obgyn G1P0A0+gemelli LSCS G1P0A0+gemelli dr.Umi SAB II/VK
44 396003 Ny.Anita W 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
45 356149 Ny.Sri Wahyuni 21th √ Ortho Union fr tibia D post plating Aff plate Union fr tibia D post plating dr.Danang SAB II/TC
Union fr radius D post Union fr radius D post
46 006543 Sdr.M.Rizky A 15th √ Ortho plating Aff plate plating dr.Danang MASKERVVIPB
47 382370 Tn.Andar Eko 27th √ Umum 05/5/2017 Ganglion poplitea S Excisi Ganglion poplitea S dr.Hernowo SAB II
48 401260 Sdr.Rijal Arifin 19th √ Ortho Fr.Clavicula Orif [plating Fr.Clavicula dr.Hari C intubasi III
49 400219 Ny.Ummariyah 39th √ Umum Ca mamae Mastectomy Ca mamae dr.Hernowo intubasi I
50 225769 Ny.Istiqomah 48th √ Umum Cholelitiasis cholesistectomy Cholelitiasis dr.Hernowo SAB II
51 401085 Tn.Akuwat 54th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
52 192723 Ny.Muflichatul M 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
53 312943 Ny.Sustiorini 39th √ Obgyn 06/5/2017 G4P1A2+BSC LSCS G4P1A2+BSC dr.Kery SAB II/VK
54 354745 Ny.Yeti Widya 43th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
55 401625 Tn.Sutaji 52th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
56 401587 Tn.M.Khoiron H 52th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB III
57 401010 Ny.Elly Triana 33th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II/TC
58 401537 Ny.Dewi Fatmawati 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
59 337113 Tn.Amin Handoko 34th √ Umum Abses perianal Incisi+debridement Abses perianal dr.Hernowo SAB II/TC
60 307543 Ny.Yuliati Retnani 32th √ Obgyn G3P2A+BSC LSCS G3P2A+BSC dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 401683 Ny.Anifah 29th √ Obgyn 07/5/2017 G2P1A0+PRM LSCS G2P1A0+PRM dr.Umi SAB II/VK
62 399485 Ny.Leli Puuspitasari 29th √ Obgyn G2P1A0+KIFL LSCS G2P1A0+KIFL dr.Umi SAB II/VK
63 256982 Ny.Immatul F 29th √ Obgyn G1P0A0+oligohidramnion LSCS G1P0A0+oligohidramnion dr.Umi SAB II/VK
64 401679 Ny.Choirul A 36th √ Obgyn G3P1A1+triple LSCS G3P1A1+triple dr.Umi SAB II/VK
65 000364 Ny.Sri Wulandari 35th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
66 309403 Ny.Nur Mahillah 39th √ Obgyn G2P1A0+letlin LSCS G2P1A0+letlin dr.Kery SAB I/VK
67 401479 Ny.Sapariatin 39th √ Umum 08/5/2017 Neurofibroma Exterpasi Neurofibroma dr.Sukarno SAB II
68 177472 Tn.Hari Wahyudi 64th √ Umum Ganglion poplitea Exterpasi Ganglion poplitea dr.Sukarno SAB I
G1P0A0+cistoma ovarii
69 400024 Ny.Ratna Budiarti 23th √ Obgyn G1P0A0+cistoma ovarii LSCS+SOD coklat dr.Kery SAB II/VK
70 201199 Ny.Arie Wahyunita 29th √ Obgyn G2P1A0+PRM sod G2P1A0+PRM dr.Kery SAB II/VK
71 293514 Ny.Nina Elfiana 48th √ Umum G2P1A0+KIFL Mastectomy G2P1A0+KIFL dr.Hernowo intubasi II
72 299333 An.Bima Cakra 3th √ Umum G1P0A0+oligohidramnion Herniotomy G1P0A0+oligohidramnion dr.Bambang masker II
73 401715 Tn.Lasmi'un 67th √ Umum G3P1A1+triple Herniotomy G3P1A1+triple dr.Hernowo SAB PAV
74 399600 Ny.Yuniar 34th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
75 173444 Ny.Muharoroh 40th √ Obgyn G2P1A0+letlin LSCS+MOW G2P1A0+letlin dr.Umi SAB I/VK
76 401413 Tn.Nu'man Bajri 53th √ Umum Neurofibroma Incisi+debridement Neurofibroma dr.Hernowo SAB III
77 401568 Ny.Morena P 27th √ Obgyn G10-0 + PP LSCS+insersi IUD G10-0 + PP dr.Umi SAB I/VK
78 398050 Ny.Asri Dwi U 33th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Umi SAB I/VK
79 401600 Ny.Novika N 32th √ Obgyn G2P1A0+post term LSCS G2P1A0+post term dr.Umi SAB III/VK
80 401749 Sdr.Achmad Nur 20th √ Ortho Cl fr femur Orif plating Cl fr femur dr.Hari C SAB II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 397736 Ny.Siti Faiqotul 22th √ Obgyn 08/5/2017 G1P0A0+nst non reaktif LSCS G1P0A0+nst non reaktif dr.Umi SAB II/VK
82 355842 Ny.Diana Ambar 37th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
83 401854 Ny.Sri Puji R 37th √ Obgyn 09/5/2017 G3P2A0+fetal distress LSCS G3P2A0+fetal distress dr.Umi SAB II/VK
84 401860 Ny.Rosidayani 26th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Umi SAB II/VK
85 382376 Ny.Siti Mas Q 29th √ Obgyn G1P0A0+nst non reaktif LSCS G1P0A0+nst non reaktif dr.Umi SAB II/VK
86 401458 Tn.Soehardi W 47th √ Umum Fibroma humerus S Exterpasi Fibroma humerus S dr.Sukarno masker I
87 401503 Ny.Yatim Dwi T 29th √ Umum FAM S Exterpasi FAM S dr.Sukarno masker II
88 401865 Ny.Durrotul Aini 24th √ Obgyn G1P0A0+asma LSCS G1P0A0+asma dr.Haris SAB II/VK
89 401830 Ny.Arita Ratno 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
90 400952 Ny.Yayuk Astuti 45th √ Umum Lipoma simpisis pubis Excisi Lipoma simpisis pubis dr.Hernowo SAB II
91 388769 An.Aidin Naufal 1th √ Umum HIL Herniotomy HIL dr.Hernowo masker II
Union fr radius ulna post Union fr radius ulna post
92 400973 Sdr.M.Imron R 18th √ Ortho plating Aff plate plating dr.Hari C masker II
93 392523 Ny.Tiarapul F 45th √ Urologi Batu phylum D Extended pyelolitotomy D Batu phylum D dr.Kristianto intubasi I
94 400122 Ny.Pujianti 36th √ Umum Lipoma paha Excisi Lipoma paha dr.Sukarno SAB III
95 399532 Ny.Beni Suryani 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
96 387371 Ny.Putri Bunga L 27th √ Obgyn G2P1A0+oligohidramnion LSCS G2P1A0+oligohidramnion dr.Haris SAB II/VK
97 368644 Ny.Retnaningasih 27th √ Obgyn G5P2A2+gemelli LSCS G5P2A2+gemelli dr.Haris SAB II/VK
98 401761 Tn.Sunyoto 64th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
99 400254 Tn.Hari M 52th √ Umum HIL Herniotomy HIL dr.Bambang SAB II
100 400987 Tn.Subari 55th √ Umum 10/05/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
101 238668 Ny.Dewi Wulandari 35th √ Umum 10/05/2017 Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB VVIPA
102 401966 Tn.Farkan 58th √ Ortho Fr metacarpal I Debridement+tendoraphy Fr metacarpal I dr.Hari C SAB III
103 383280 Ny.Silvia Andriana 35th √ Obgyn G4P3A0+BSCS LSCS+MOW G4P3A0+BSCS dr.Umi SAB II/VK
104 238432 Ny.Vircy Nabila 23th √ Obgyn G1P0A0+oligohihramnion LSCS G1P0A0+oligohihramnion dr.Umi SAB II/VK
105 402065 Ny.Iswati 37th √ Obgyn 11/05/2017 G2P0A0+BSC LSCS G2P0A0+BSC dr.Haris SAB II/VK
106 402063 Ny.Yeni Dwi I 27th √ Obgyn KET SOD KET dr.Haris SAB PAV
107 399836 Ny.Eko Prasetyo 21th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Haris SAB III/VK
108 402277 Ny.Lilik F 28th √ Obgyn G2P1A0+PPLR LSCS G2P1A0+PPLR dr.Haris SAB II/VK
109 401805 An.Farras Arga 11th √ Umum 12/05/2017 HIL Herniotomy HIL dr.Sukarno SAB III
110 243705 Tn.Supadi 48th √ Umum Multiple lipoma Exterpasi Multiple lipoma dr.Sukarno masker II
G2P1A0+PROM+ket
111 262719 Ny.Yuni Ernia 27th √ Obgyn G2P1A0+PROM LSCS mekoneal dr.Umi SAB I/VK
112 260353 Ny.Tatik Nelis S 36th √ Obgyn G4P2A1+BSC LSCS+insersi IUD G4P2A1+BSC dr.Umi SAB II/VK

113 373928 Ny.Nia Novita 39th √ Umum Appendictomy Appendicitis akut dr.Sukarno II
Appendicitis akut SAB
Obgyn Oovarectomy S Torsi cista ovarium S dr.Umi
114 311105 Ny.Siti Muslichah 47th √ Umum Mamae abrant Excisi Mamae abrant dr.Hernowo masker II
115 401972 Ny.Ernawati 37th √ Umum Lipoma punggung Excisi Lipoma punggung dr.Hernowo TIVA II
DM+nekrose digiti II,III pedis DM+nekrose digiti II,III pedis
116 401849 Ny.Suparmi 62th √ Umum D
Debridement+amputasi
D dr.Hernowo SAB III
117 264882 Ny.Siti Machnunah 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
118 402162 Ny.Ira Indriyani 33th √ Umum 13/05/2017 Mamae aberant Excisi Mamae aberant dr.Bambang masker II
119 384410 Tn.Darus dansiki 33th √ Umum Hemangioma Excisi Hemangioma dr.Bambang masker I
120 386559 Nn.Anggi susanti 18th √ Umum Fam Multiple Excisi Fam Multiple drSukarno masker III

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI

121 402158 Ny.Wati indahyani 40th √ Umum 13/05/2017 Fam Multiple Excisi Fam dr.bambang Masker III/TC

122 402078 Nn.Dyah Puspitarini 19th √ Umum Lipoma Punggung Exterpasi Lipoma Punggung dr.Sukarno Masker III

123 341480 Tn.Iwan priyono 28th √ Umum Hil Residif Herniotomy Hil Residif dr.Hernowo SAB II

124 276526 sdr.M.Hilmi 15th √ Umum Appendikcitis Appendiktomy Appendikcitis dr.Hernowo SAB III

125 402182 Ny.Siti khuriyatin 47th √ Ortho Fr.Metatarsal Digit IV Orif pining Fr.Metatarsal Digit IV dr.Hari C Masker III
126 4021266 NySulastri 42th √ Ortho Fr.Digiti Manus I Orif pining Fr.Digiti Manus I dr.Hari C Masker II

127 401379 Nn.Izmi 30th √ Umum Appendik acut Appendiktomy Appendik acut dr.Hernowo SAB II

128 384078 Ny.Endang S 33th √ Obgyn G2P1-1A0+BSC SCTP + IUD G2P1-1A0+BSC dr.umi SAB III/VK

129 401161 Ny.Sufiati 31th √ Obgyn G2P1-1A0|+Peb+bsc LSCS G2P1-1A0|+Peb+bsc dr.umi SAB II/VK

130 400486 Ny.Patmini 36th √ Obgyn G4P2-1A1+PRM LSCS G4P2-1A1+PRM dr.umi SAB II/VK

131 402283 Ny.Ninik Puji 24th √ Obgyn 14/05/2017 G1P0-0+KPP LSCS G1P0-0+KPP dr.Heru B SAB III/VK

132 400232 ny.maria ulfa 39th √ Obgyn 15/05/2017 G3P2-2+BSC2x LSCS + MOW G3P2-2+BSC2x dr.kery SAB II/VK

133 401894 Ny.Winiarti 48th √ Obgyn myoma uteri SVH + BSO myoma uteri dr.Haris SAB I/VK

134 400407 Ny.Saporiyah 48th √ Umum Batu empedu Cholecystectomy Batu empedu dr.Bambang SAB I

135 223264 tn.gatot Purwanto 35th √ Umum Hil Residif Herniotomy Hil Residif dr.Hernowo SAB II

136 401784 An.Ananda felisa 12th √ Umum Dermoid cyste Excisi Dermoid cyste dr.Hernowo TIVA II

137 390802 Tn.ahmadi S 54th √ Umum Hil Herniotomy Hil dr.Hernowo SAB I

138 224177 Ny.Wahyuni k 27th √ Obgyn G2P1-1A0+BSC LSCS G2P1-1A0+BSC dr.umi SAB II/VK

139 259921 Ny.Firma Dwi A 26th √ Obgyn 16/05/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.kery SAB II/VK

140 402329 Ny.Yuliani 28th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.kery SAB II/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017
KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
141 401903 Tn.M.Yas'ud 46th √ Umum 16/05/2017 Atheroma pipi Exterpasi Atheroma pipi dr.Sukarno TIVA II
142 402352 Ny.Lastriana 37th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
143 323376 Ny.Yenny S 33th √ Obgyn G3P1A1+PEB LSCS G3P1A1+PEB dr.Umi SAB II/VK
144 377802 Ny.Nanik Hidayati 46th √ Obgyn Mioma uteri SVH+salpingectomy Mioma uteri+hidrosalping D dr.Kery SAB II/VK
145 312180 Ny.Suhartin 30th √ Obgyn G2P1A0+PROM LSCS G2P1A0+PROM dr.Umi SAB II/VK
146 402460 Ny.Istiqomah 24th √ Obgyn G2P0A1+oligohidramnion LSCS G2P0A1+oligohidramnion dr.Kery SAB III/VK
147 402477 Ny.Yuliani 32th √ Obgyn G2P1A+partus lama LSCS G2P1A+partus lama dr.Kery SAB II/VK
148 399108 Ny.Yauni R 29th √ Obgyn 17/05/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
149 402377 Ny.Anita Fitriana 20th √ Umum Fam Exterpasi Fam dr.Sukarno SAB II
150 270607 Ny.Aisus Silmi 33th √ Umum Appendicitis acut Appendictomy Appendicitis acut dr.Sukarno SAB II
151 400152 Ny.Herny S 46th √ Umum Struma multi nodusa Sub total lobectomy Struma multi nodusa dr.Sukarno Intubasi I
152 320366 Ny.Mufiana M 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
Corpus alienum scrup cruris Corpus alienum scrup cruris
153 010012 Tn.Khambali 48th √ Umum D
Exterpasi+debridement
D dr.Hernowo SAB II
154 675664 An.M.Hafid F 11th √ Umum Phymosis Circumsisi Phymosis dr.Heru B masker I
155 299680 Ny.Nikmatul F 45th √ Umum Appendic kronis Appendictomy Appendic kronis dr.Hernowo SAB VVIPA
156 324992 Ny.Iif Makrifatul 26th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB III/VK
157 374323 Ny.Dian P 22th √ Obgyn G1P0A0+PP marginalis LSCS G1P0A0+PP marginalis dr.Umi SAB II/VK
158 360841 Ny.Rosa Muhtarosa 25th √ Obgyn G2P0A1+nst non reaktiif LSCS G2P0A1+nst non reaktiif dr.Umi SAB II/VK
159 386762 Ny.Safa'ah N 34th √ Obgyn G3P2A0+fetal distres LSCS G3P2A0+fetal distres dr.Heru B SAB II/VK
160 402639 Ny.Nur Hidayati 35th √ Obgyn 18/05/2017 G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
161 402376 Ny.Dwi Yuliana 28th √ Obgyn 18/05/2017 G1P0-0 + Visus 4 LSCS G1P0-0 + Visus 4 dr.Kery SAB II/VK
162 395548 Ny.Lusni liberti 57th √ Umum Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno TIVA III
163 265111 Tn.I nyoman s 52th √ Umum Hematoma inguinal Evaluasi hematom Hematoma inguinal dr.Hernowo SAB II
164 401883 Tn.Sukir 63th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
165 402560 Nn.Dian nur kumala 18th √ Umum Fam Exterpasi Fam dr.Bambang Masker II
166 402220 Ny.Sayidatul 30th √ Umum G1P0-0+CPD LSCS G1P0-0+CPD dr.Umi SAB I/VK
167 402422 Tn.M.Khanif 26th √ Ortho Fr,Antebrachii Aff Plate Fr,Antebrachii dr.Hari C Masker II/TC
168 360175 Tn.Nurul Siswanto 44th √ Urologi Batu Pyelum Pyelolitotomi Batu Pyelum dr.Kristianto Intubasi I
169 390713 Ny.Martdiana 36th √ Obgyn G3P2-2+bsc+iud LSCS + IUD G3P2-2+bsc+iud dr.Umi SAB II/VK
170 402016 Ny.Choiriyah Apriliani 24th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
171 402657 Ny.Nur Aini 43th √ Obgyn Abortus Incomplete Curetage Abortus Incomplete dr.Umi SAB III/VK
172 402120 Ny.Entin Tismiania 27th √ Obgyn G3P2-2 + Post term LSCS G3P2-2 + Post term dr.Umi SAB II/VK
173 402442 Tn.Sukardi 52th √ Umum 19/05/2017 Lipoma punggung Excisi Lipoma punggung dr.Sukarno TIVA II
174 321380 Ny.Diamra S 33th √ Obgyn Abortus Incomplete Curetage Abortus Incomplete dr.Kery SAB II/VK
175 292867 Ny.Mustika Sari 24th √ Obgyn G1P0-0 Hight Miopi LSCS G1P0-0 Hight Miopi dr.Umi SAB I/VK
176 198009 Ny.Miro Farihawati 32th √ Obgyn G4P3-3 + BSC 3x LSCS + MOW G4P3-3 + BSC 3x dr.Umi SAB I/VK
177 402616 Tn.M.Izul H 27th √ Umum Tu.Sub Mandibula Excisi Tu.Sub Mandibula dr.Bambang Intubasi II/TC
178 400985 Ny.Ismiati 52th √ Umum Ca.Mamae MRM Ca.Mamae dr.Hernowo Intubasi III
179 307156 Ny.Fauziatun A 42th √ Umum Tu.Femur Excisi Tu.Femur dr.Hernowo SAB II
180 402683 An.Nikmatul M 10th √ Umum Appendik Acut Appendiktomy Appendik Acut dr.Hernowo SAB III

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
181 402290 Tn.Suyanto 49th √ Umum 19/05/2017 Ulcus Pedis Debridemen Ulcus Pedis dr.Hernowo SAB III
182 273369 Ny.Lilik Endang 39th √ Umum 20/05/2017 Ganglion Poplitea Excisi Ganglion Poplitea dr.Sukarno SAB II
183 401282 Ny.Lia Marliana 21th √ Obgyn G2P0A1-1+PP Partialis LSCS G2P0A1-1+PP Partialis dr.Umi SAB III
184 402811 Ny.Fenny Cahya 32th √ Obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Kery SAB I
185 213641 Ny.Saidatul 31th √ Umum FAM Excisi FAM dr.Bambang Masker II/TC
186 398084 Ny.Nova Varianti 33th √ Obgyn G3P2-2 +PLR LSCS + MOW G3P2-2 +PLR dr.Umi SAB II/VK
187 254085 Ny.Novi Widayanti 28th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
188 388893 Ny.Dewi Madya 36th √ Obgyn G4P1-1A2 + PLR LSCS G4P1-1A2 + PLR dr.Umi SAB II/VK
189 354572 Ny.Nur Anita 29th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
190 385489 Ny.Ifa Noor 29th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
191 385536 Ny.Risky dianshela 27th √ Obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Umi SAB II/VK
192 402582 TnHeri Ardianto 27th √ Ortho OP.Fr.Metacarpal dg I,2,3,4 Orif Pining OP.Fr.Metacarpal dg I,2,3,4 dr.Danang Intubasi II
193 391869 Tn.Safrudin 46th √ Ortho Union Fr. Radius Ulna aff plate Union Fr. Radius Ulna dr.Danang Intubasi II
194 331032 Ny.Sintowati 66th √ Ortho Union Fr,Ankle aff plate Union Fr,Ankle dr.Danang SAB II
195 402914 Ny.Ririn titik 30th √ Obgyn 21/05/2017 G3P0-020 LSCS G3P0-020 dr.Umi SAB I/VK
196 273648 Ny.Willya Christiva 37th √ Obgyn G1P0-0 + Abortus Curetage G1P0-0 + Abortus dr.Umi SAB II/VK
197 401237 Ny.Khoirul Uliyah 38th √ Obgyn 22/05/2017 G3P2-1 +BSC LSCS + MOW G3P2-1 +BSC dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
198 003281 Ny.Akhisin 38th √ Obgyn 22/05/2017 Cystooma ovarii SOS + Tubectomy Cystooma ovarii dr.Kery SAB II/VK
199 402493 Tn.Ranu 56th √ Umum Ganglion poplitea Exterpasi Ganglion poplitea dr.Sukarno SAB II
200 395492 Ny.Heny Taslimah 40th √ Obgyn Polip Cervix Exterpasi + curetage Polip Cervix dr.Heru B SAB II/VK
201 000320 Ny.Wiwied Dianita 36th √ Obgyn G2P1-1+Post SC LSCS + IUD G2P1-1+Post SC dr.Umi SAB I/Vk
202 402597 NN.Utari Silviarini 25th √ Umum Fam Excisi Fam dr.Hernowo Masker II
203 333080 Ny.Andria Fitriani 34th √ Umum Lipoma Punggung Excisi Lipoma Punggung dr.Hernowo TIVA II
204 402744 Ny.Lilik Susanti 37th √ Umum Fam Excisi Fam dr.Hernowo Masker II
205 402754 Ny.Polma D Malau 31th √ Obgyn G1P0-0 + PP Lscs G1P0-0 + PP dr.Umi SAB II/VK
206 235501 Ny.Firma dwi 25th √ Obgyn G3P2-2+BSC 2x LSCS + IUD G3P2-2+BSC 2x dr.Umi SAB II/VK
207 338386 Sdr.Rizky Junaedy 28th √ Ortho Mal Union Fr,Radius Rekonstruksi + Plating Radius Mal Union Fr,Radius dr.Danang Intubasi II/TC
208 357343 Ny.Jumrotul 51th √ Urologi Strictur Uretra TUR Strictur Uretra dr.Kristianto SAB I
209 402572 Ny.Nita Wulandari 26th √ Obgyn G1P0-0 + Hight Miopi LSCS G1P0-0 + Hight Miopi dr.umi SAB II/VK
210 336451 Ny.Ivana ariani 34th √ Obgyn G3P2-2A0 + PROM+ BSC LSCS + IUD G3P2-2A0 + PROM+ BSC dr.umi SAB I/Vk
211 342653 Ny.Wahyuni 35th √ Obgyn Abortus incomplete Curetage Abortus incomplete dr.umi SAB I/Vk
212 383746 Ny.Tri Sofiani 35th √ Obgyn Abortus incomplete Curetage Abortus incomplete dr.umi SAB II/VK
213 403042 Ny.Yuni Urifah 34th √ Obgyn 23/05/2017 G2P1-1+Post SC LSCS G2P1-1+Post SC dr.Kery SAB III/VK
214 260252 Ny.Anita Dewi 34th √ Obgyn G2P1-1+Post SC LSCS G2P1-1+Post SC dr.Kery SAB II/VK
215 401445 Ny.Kurnia Isrotun 21th √ Obgyn G1P0-0 +PROM LSCS G1P0-0 +PROM dr.Umi SAB III/VK
216 403041 Ny.Phobi Silviadhika 28th √ Obgyn G2P1-1+Post SC LSCS G2P1-1+Post SC dr.Kery SAB II/VK
217 241495 Ny.Widiya Kuswatini 39th √ Obgyn G5P3-3A1 +PEB LSCS + MOW G5P3-3A1 +PEB dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
218 399228 Ny.Hanna Putri 25th √ Obgyn 23/05/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB III/VK
219 399234 Ny.Ninik Nuryati 32th √ Obgyn G1P0-0 + PLR LSCS G1P0-0 + PLR dr.Kery SAB II/vk
220 402333 Ny.Sarmiati 48th √ Obgyn Myoma Uteri+cyste Ovarii SVH + SOS Myoma Uteri+cyste Ovarii dr.Kery SAB II/vk
221 389125 Ny.Neilza Ika 46th √ Obgyn Myoma Uteri+cyste Ovarii SVH + SOD Myoma Uteri+cyste Ovarii dr.Kery SAB II/vk
222 401789 Ny.Astuty 32th √ Obgyn myoma uteri SVH myoma uteri dr.Kery SAB III/VK
223 344477 Tn.Sarwoko 43th √ Umum Hil Herniotomy Hil dr.Hernowo SAB II
224 403004 Ny.Sri Pujianti 24th √ Obgyn G1P0-0 + post term LSCS G1P0-0 + post term dr.Umi SAB II/vk
225 357420 Ny.Fanani 37th √ Obgyn Abortus incomplete curetage Abortus incomplete dr.Kery SAB III/VK
226 237224 Ny.Nila Framita 29th √ Obgyn Abortus incomplete curetage Abortus incomplete dr.Umi SAB II
227 403014 Ny.Sri Temu aji 59th √ Obgyn cystoma ovarii SOD + Myomectomy cystoma ovarii dr.Kery SAB II/vk
228 402079 Ny.Evi Widiastutik 36th √ Umum 24/05/2017 Galatosa Tu.Mamae Exterpasi Galatosa Tu.Mamae dr.Sukarno Intubasi I
229 400671 Ny.Ninung Pujiastuti 35th √ Obgyn G3P2-2 +PEB+BSC LSCS G3P2-2 +PEB+BSC dr.Umi SAB I/VK
230 403128 Ny.Indah Lalilatul 21th √ Obgyn G1P0-0 + Kep.Floting LSCS G1P0-0 + Kep.Floting dr.Haris SAB III/VK
231 347355 Ny.Yuni Budiarni 34th √ Obgyn G2P1-1 + Fetal DisstresLSCS G2P1-1 + Fetal Disstresdr.Haris SAB I/VK
232 401483 Ny.Ines S 26th √ Obgyn G2P1-1 + KPP + BSC LSCS G2P1-1 + KPP + BSC dr.Haris SAB II/vk
233 398955 Tn.Miskan 53th √ Ortho mal union Cl.Fr.Radius distal Orif pining mal union Cl.Fr.Radius distal dr.Danang Masker II/TC
234 400038 Tn.Ronald Karfarino 33th √ Umum Tu.Parotis Excisi Tu.Parotis dr.Hernowo TIVA II
235 402420 Tn.M.Budiarso 65th √ Umum Tu.Sub.Mandibula Excisi Tu.Sub.Mandibula dr.Hernowo Intubasi I
236 198793 Tn.Harry Subekti 40th √ Umum Appendik acut Lap.Appendiktomy App.Perforasi dr.Hernowo SAB VVIPB
237 388148 Ny.Yuni Wonokitri 34th √ Obgyn G3P2-2 +PROM + Haemmoroid LSCS G3P2-2 +PROM + Haemmoroid dr.umi SAB II/vk
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
238 221242 Ny.Reza megawati 27th √ Obgyn G2P1-1 + PP + BSC LSCS G2P1-1 + PP + BSC dr.Umi SAB II/VK
239 403080 Ny.Yani Purwati 28th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
240 401060 Ny.susiani 33th √ Obgyn G3P2-2 + BSC 2x LSCS + MOW G3P2-2 + BSC 2x dr.Umi SAB II/VK
241 386887 Ny.Ni wayan S 39th √ Obgyn G3P2-2 + BSC 2x+ PP LSCS + MOW G3P2-2 + BSC 2x+ PP dr.Umi SAB I/VK
242 385397 Ny.Mubariroh 27th √ Obgyn 25/05/2017 G1P0-0 + PRM LSCS G1P0-0 + PRM dr.Kery SAB VIPA
243 403247 Ny.Diana Sasmita 24th √ Obgyn G2P1-1 + Letsu LSCS G2P1-1 + Letsu dr.Haris SAB II/VK
244 403266 Ny.Imroatun N 25th √ Obgyn G1P0-0 + Letsu LSCS G1P0-0 + Letsu dr.Haris SAB II/VK
245 403277 Ny.Anes Nurani 37th √ Obgyn G3P2-2 + Letsu LSCS G3P2-2 + Letsu dr.Haris SAB II/VK
246 248873 Ny.Anis Tia A 30th √ Umum 26/05/2017 Appendik Acut Appendiktomy Appendik Acut dr.Sukarno SAB II
247 403179 Nn.Muclisah 18th √ Umum Fam Excisi Fam dr.Hernowo Masker III
248 402246 Nn.Siti fatimah 21th √ Umum Fam Excisi Fam dr.Hernowo Masker III
249 403254 An.Leon Adam 8th √ Ortho Cl.Fr.Humeri Orif Plating Humeri Cl.Fr.Humeri dr.Danang Intubasi II/TC
250 340139 Ny.Hera Wahyu 36th √ Obgyn G4P2A1+BSC1x+PRM LSCS G4P2A1+BSC1x+PRM dr.Kery SAB II/VK
251 402813 Tn.M.Budi 62th √ Umum 27/05/2017 Abses Perianal Incisi + Debridement Abses Perianal dr.Hernowo SAB III
252 401908 Ny.Ririn 32th √ Obgyn G7P4-4A3+Anemia+BSC LSCS + MOW G7P4-4A3+Anemia+BSC dr.Umi SAB I
253 403418 Ny.Retno wulan 21th √ Obgyn 28/05/2017 G1P0-0 + PROM LSCS G1P0-0 + PROM dr.Umi SAB II/VK
254 403182 Ny.Nurul Khanifah 38th √ Obgyn 29/05/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB III/VK
255 403457 Ny.Nena Wahyuni 28th √ Obgyn G3P1-1A1+BSC LSCS G3P1-1A1+BSC dr.Kery SAB I/VK
256 387478 Ny.drg.Dini safitri 38th √ Obgyn G2P1-1+BSC LSCS + MOW G2P1-1+BSC dr.Umi SAB I/VK
257 271257 Ny.Luluk chusnul K 45th √ Umum Fam Excisi Fam dr.Hernowo Masker II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : MEI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
258 403290 Tn.Suryo Ardianto 44th √ Umum Tu.Punggung Excisi Tu.Punggung dr.Bambang TIVA II
259 402845 Ny.Nurroh Hidayati 21th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Bambang Masker II/TC
260 402368 Ny.Uhroju Hayyah 33th √ Obgyn G3P2-2 +BSC LSCS + MOW G3P2-2 +BSC dr.Umi SAB II/VK
261 188218 Ny.Izzati C 26th √ Obgyn G2P1-1+oligohidramnio LSCS G2P1-1+oligohidramnio dr.Umi SAB II/VK
262 403508 Ny.Isnanik 40th √ Obgyn 30/05/2017 G2P1-1 +Haemoroid LSCS + MOW G2P1-1 +Haemoroid dr.Kery SAB III/VK
263 403479 Ny.Yuliatiningsih 38th √ Obgyn G5P2-1A2+BSC 2x LSCS G5P2-1A2+BSC 2x dr.Kery SAB II/VK
264 395019 Ny.LinaAgus 33th √ Obgyn G2P1-1 +BSC LSCS G2P1-1 +BSC dr.Kery SAB II/VK
265 209980 Ny.Siti Latifah 39th √ Obgyn G3P2-2 + letsu LSCS + MOW G3P2-2 + letsu dr.Kery SAB II/VK
266 400300 Ny.Nur Rosidah 33th √ Obgyn G4P2-2A1+BSC 2x LSCS + MOW G4P2-2A1+BSC 2x dr.Umi SAB II/VK
267 402593 Ny.AnaSusanti 37th √ Obgyn G3P1A1 +PP+BSC LSCS + MOW G3P1A1 +PP+BSC dr.Kery SAB III/VK
268 403599 Ny.Eni Maryamah 32th √ Obgyn G4P1-A2+BSC LSCS G4P1-A2+BSC dr.Kery SAB II/VK
269 3995501 Tn.Suharmaji 54th √ Urologi Stricture uretra Sache Stricture uretra dr.Kristianto SAB III
270 399320 Ny.Uswatun k 35th √ Obgyn Dead Conceptus Curetage Dead Conceptus dr.Umi SAB II/VK
271 333534 Ny.Aminah 35th √ Obgyn 31/05/2017 Cystoma Ovarii Cystectomy Cystoma Ovarii dr.Kery SAB II/VK
272 387571 Ny.Susianingsih 27th √ Obgyn G2P1-1+BSC LSCS G2P1-1+BSC dr.Kery SAB II/VK
273 281849 Tn.Suhartini 54th √ Umum Granuloma Pedis Excisi Granuloma Pedis dr.Hernowo SAB II/TC
274 403590 Ny.Tri Wahyu Dian 29th √ Obgyn G1P0-0 + CPD LSCS G1P0-0 + CPD dr.Umi SAB II/VK
275 400966 Ny.Imroatun Nadiyah 43th √ Obgyn Cyste Ovarii Oovorectomy Partial Cyste Coklat Ovarium dr.Umi SAB II/VK
G1P0-0+post term + G1P0-0+post term +
276 403310 Ny.dewi Puri Lestari 22th √ Obgyn Haemmoroid LSCS Haemmoroid dr.Umi SAB II/VK
277
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : ......................... TAHUN 2016

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
2/I √ √ √

3/I √ √ √

3/I √ √ √

1/I √ √ √

1/II √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √
1/III √ √ √
2/III √ √ √

4/I √ √ manulife
3/I √ √

2/I √ √ √

3/I √ √ √
1/I √ √ √

3/II √ √ √

1/II √ √ √

4/I √ √ √

1/II √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono Ny.Fita Agus S

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

2/III √ √ √

2/II √ √ √

1/I √ √ √

3/I √ √ √

3/II √ √ √
2/I √ √ √

1/II √ √ √

2/IV √ √ √

1/II √ √ √

2/III √ √ √

3/III √ √ √

2/IV √ √ √

3/II √ √ √

2/III √ √ √

2/I √ √ √

1/I √ √ RBH
3/I √ √ √

3/II √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

1/II √ √ √

4/I √ √ √

2/III √ √ √

4/II √ √ √

4/IV √ √ JCI
1/III √ √ √

4/III √ √ √

2/IV √ √ √

2/V √ √ √

1/IV √ √ √

3/IV √ √ √

3/I √ √ √

2/I √ √ √
3/I √ √ √
1/I √ √ √
1/II √ √ √
2/II √ √ √
1/III √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

2/III √ √ √

3/III √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √
2/II √ √ √

1/III √ √ √

2/III √ √ √

1/IV √ √ √

3/II √ √ √

1/IV √ √ √

2/IV √ √ √

3/III √ √ √

4/II √ √ √

4/I √ √ JASA RAHARJA


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/IV √ √ √

4/III √ √ √
2/I √ √ √

3/I √ √ √

4/I √ √ √

4/II √ √ √

4/I √ √ √

2/I √ √ √

1/I √ √ √

3/I √ √ √

2/II √ √ √

4/III √ √ √

2/II √ √ √

1/I √ √ √

3/I √ √ √

2/I √ √ √

4/I √ √ √

1/II √ √ √

1/III √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi
Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ AIA
4/I √ √ √

3/III √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

2/II √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ √

1/I √ √ √
2/III √ √ √

4/I √ √ √

1/II √ √ √

3/III √ √ √

1/III √ √ √

3/I √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

1/II √ √ JAI
2/III √ √ √

1/II √ √ √

1/II √ √ √
4/I √ √ √

1/|II √ √ √

2/IV √ √ √

3/III √ √ √

2/V √ √ √

3/I √ √ √

3/I √ √ √

2/I √ √ √

4/I √ √ √

2/II √ √ √

1/I √ √ √

2/III √ √ √

3/II √ √ √

2/I √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

3/II √ √ √

2/II √ √ √

1/II √ √ √

3/III √ √ √

2/III √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

2/II √ √ √

3/II √ √ √

1/II √ √ jci
comfe
2/III √ √ d
1/III √ √ simas
3/V √ √ √

2/IV √ √ inhealth
3/IV √ √ √

3/V √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/II √ √ √

3/II √ √ √

2/II √ √ √

1/II √ √ √

4/I √ √ √

4/I √ √ RBH
2/III √ √ √

3/IV √ √ √
1/III √ √

2/IV √ √

3/IV √ √ √

2/I √ √ √

1/I √ √ √

3/I √ √ √

2/II √ √ √

4/I √ √ √

2/II √ √ √

1/II √ √ √

1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/IV √ √ √
1/I √ √ √ √

2/I √ √ √

3/I √ √ √

2/III √ √ SFI
2/II √ √ √

3/III √ √ √

1/II √ √ √

3/II √ √ √

3/IV √ √ √

1/III √ √ √

4/I √ √ √

3/II √ √ √

4/II √ √ √

2/I √ √ √

1/I √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/I √ √ √

3/II √ √ √

2/II √ √ √

2/III √ √ √

1/I √ √ √

1/III √ √ √

3/II √ √ √

2/IV √ √ √

4/! √ √ √

2/III √ √ √

3/IV √ √ √

1/III √ √ √

1/IV √ √ √

3/V √ √ √

2/I √ √ √
4/! √ √ √

1/I √ √ √

3/II √ √ √

3/I √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

3/III √ √ √

2/III √ √ √

3/III √ √ √

2/IV √ √ √

1/II √ √ √

4/I √ √ √

2/V √ √ √
3/IV √ √ inhealth
3/IV √ √ √

1/II √ √ √

3/III √ √ √

3/I √ √ √

2/I √ √ √

3/III √ √ √

4/I √ √ √

2/IV √ √ √

2/II √ √ √

1/II √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

3/V √ √ √

2/V √ √ √

3/IV √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

2/I √ √ paket
1/II √ √ √

4/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

3/I √ √ √

2/I √ √ √

3/I √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

1/II √ √ JAI
2/II √ √ √

3/II √ √ √

2/II √ √ √

2/II √ √ √

1/I √ √ √

3/II √ √ √

3/II √ √ √

3/III √ √ √

1/II √ √ √

2/III √ √ √
1/III √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

3/II √ √ √

2/III √ √ √

Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 403754 Ny.Hanifah 27th √ Obgyn 01/06/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
2 215175 Ny.Farikah 37th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB I/VK
3 403762 Ny.Firda Ardina 24th √ Obgyn G3P0A0+fetal distress LSCS G3P0A0+fetal distress dr.Umi SAB III/VK
4 247597 Ny.Puri Indah S 30th √ Obgyn 02/06/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB III/VK
5 403777 Ny.Siti Robi'ah 38th √ Obgyn G3P2A0+PPT LSCS+MOW G3P2A0+PPT dr.Kery SAB II/VK
6 402960 Ny.Sriani 46th √ Obgyn Mioma uteri SVH+SOD Mioma uteri+cistoma ovarii dr.Kery SAB II/VK
7 403624 Ny.Inezya Juanita 19th √ Umum FAM Exterpasi FAM dr.Sukarno Masker II
8 390079 Ny.Yudith P 29th √ Obgyn G2P1A0+BSC LSCS+MOW G2P1A0+BSC dr.Umi SAB I/VK
G3P2A0+BSC+kelainan
9 400327 Ny.Noer Fitri 38th √ Obgyn G3P2A0+BSC LSCS+MOW konginetal dr.Umi SAB II/VK
10 277785 Ny.Titan Wahyu 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
11 403714 Ny.Rini Kustiana 32th √ Obgyn G2P1A0+bayi besar LSCS G2P1A0+bayi besar dr.Heru B SAB II/VK
12 382307 Ny.Rikawati 36th √ Obgyn G2P1A0+ketuban sedikit LSCS G2P1A0+ketuban sedikit dr.Heru B SAB II/VK
13 399232 Ny.Riska Liamita 25th √ Obgyn 03/06/2017 G2P0A1+letsu LSCS G2P0A1+letsu dr.Kery SAB II/VK
14 250928 Ny.Khoirul R 24th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB II/VK
15 000359 Ny.ShintaJamilatus 24th √ Obgyn G1O0A0+PRM LSCS G1O0A0+PRM dr.Kery SAB II/VK
16 306184 Ny.Lailiyul Q 30th √ Obgyn G3P2A0+PEB+BSC LSCS+MOW G3P2A0+PEB+BSC dr.Kery SAB III/VK
17 403832 An.Roroh A 9th √ Ortho Cl fr antebrachi Reposisi Cl fr antebrachi dr.Hari C Masker II/TC
18 223998 Tn.Arie H 31th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB II/TC
19 403476 Tn.Abd.Rachman 73th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III/TC

20 401670 Ny.Fransisca 21th √ Obgyn G1P0A0+PP LSCS+insersi IUD G1P0A0+PP dr.Umi SAB I/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 403920 Ny.Erlina Fifi 33th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
22 401672 Ny.Elok Kartika 24th √ Obgyn G1P0A0+NSTnon reaktif LSCS G1P0A0+NSTnon reaktif dr.Umi SAB III/VK
23 384184 Ny.Dewi Sekar 24th √ Obgyn G2P1A0+oligohidramnion LSCS G2P1A0+oligohidramnion dr.Umi SAB II/VK
24 310983 Ny.Masriyah 29th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
25 341070 Nn.Lym Mayshah 21th √ THT Abses sub m,andibula Incisi Abses sub m,andibula dr.Noer Sofi TIVA III
26 403322 Ny.Azza Aulia R 26th √ Obgyn 05/06/2017 G1P0A0+Visus -5 LSCS G1P0A0+Visus -5 dr.Kery SAB II/VK
27 402201 Ny.Winarti 31th √ Obgyn G2P0A1+PPT LSCS G2P0A1+PPT dr.Umi SAB II/VK
28 401898 Ny.Aprilia Wati R 27th √ Obgyn G3P0A2+PP marginalis LSCS G3P0A2+PP marginalis dr.Umi SAB II/VK
29 402117 Tn.Baharudin 51th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
30 403659 An.Uwais Al Fatih 1th √ Urologi Post circumsisi Repair post circumsisi Post circumsisi dr.Kristianto masker III
31 212520 Ny.Ani Yupita 31th √ Umum Appendicitis kronis Appendictomy Appendicitis kronis dr.Hernowo SAB III
32 403928 Tn.M.Yunus 50th √ Ortho Nekrosis digiti II pedis D Amputasi+debridement Nekrosis digiti II pedis D dr.Hernowo SAB I
33 352564 Ny.Juwariyah 43th √ Obgyn Cistoma ovarii SOS Cistoma ovarii dr.Umi SAB III/VK
34 350418 Ny.Sri Utami 28th √ Obgyn G4P3A1+NST non reaktif LSCS+insersi IUD G4P3A1+NST non reaktif dr.Umi SAB II/VK
35 365833 Ny.Fathiyah M 36th √ Obgyn G4P3A0+NST non reaktif LSCS G4P3A0+NST non reaktif dr.Umi SAB II/VK
36 404058 Tn.Hartojo Budi 72th √ Ortho Op fr digiti IV manus S Debridement Op fr digiti IV manus S dr.Hari C masker II/TC
37 231597 Ny.Sariati 24th √ Obgyn 06/06/2017 G2P1A0+PROM LSCS G2P1A0+PROM dr.Umi SAB II/VK
38 403987 Ny.Dian Prasetyo 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
39 401554 Ny.Titik Dwi S 25th √ Obgyn G3P1A1+haemoroid LSCS G3P1A1+haemoroid dr.Kery SAB I/VK
40 319988 Ny.Farida Ariyani 47th √ Obgyn IUD insitu+menometrorargi Extrsksi IUD+biopsi IUD insitu+menometrorargi dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 312280 Ny.Yessy Aprianti 34th √ Umum FAM Excisi FAM dr.Hernowo masker VVIPA

42 404112 Ny.dr.Chairunnisa 28th √ Obgyn G1P0A0+gemelli LSCS G1P0A0+gemelli dr.Kery SAB I/VK
43 402791 Tn.M.Ichsan 33th √ Urologi Varicocle S Vasoligasi tinggi palomo S Varicocle S dr.Kristianto SAB I
44 403085 Tn.M.Zainal Abidin 29th √ Urologi Varicocle S Vasoligasi tinggi palomo S Varicocle S dr.Kristianto SAB III
45 226841 Ny.Ainun Nurin 24th √ Obgyn G1P0A0+TB kelenjar LSCS G1P0A0+TB kelenjar dr.Umi SAB II/VK
46 273658 Ny.Sofuroh Ambar 30th √ Obgyn G2P1A0+Oligohidramnion LSCS G2P1A0+Oligohidramnion dr.Umi SAB II/VK
47 403029 Tn.Sholikin 35th √ Ortho Fibro xhantom D Excisi Fibro xhantom D dr.Hari C SAB I
48 388542 Ny.Yunita 28th √ Obgyn 07/06/2017 G1P0A0+High miopi LSCS G1P0A0+High miopi dr.Kery SAB III/VK
49 389543 Ny.Siti Santi 34th √ Obgyn G3P1A1+PP LSCS G3P1A1+PP dr.Kery SAB II/VK
50 404158 Ny.Lilis Kurniawati 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
51 400685 Ny.Mudaimah 37th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
52 404133 Tn.Roo Zhongjian 44th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Sukarno SAB I/TC
53 354629 Ny.Dery A 26th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Haris SAB II/VK
54 404034 Nn.Miftahul I 22th √ Umum FAM Excisi FAM dr.Hernowo masker III
55 281542 Ny.Binti Masruroh 39th √ Obgyn G3P2A0+letlin LSCS+MOW G3P2A0+letlin dr.Umi SAB II/VK
56 400293 Ny.Nur Aini 34th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB III/VK
57 394414 Ny.Niken Tri 26th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB I/VK
58 313510 Ny.Ardita Wijaya 39th √ Obgyn G3P2A0+PPM LSCS G3P2A0+PPM dr.Umi SAB II/VK
59 323489 Ny.Yuyun Sri H √ Obgyn G5P3A1+BSC LSCS+MOW G5P3A1+BSC dr.Umi SAB II/VK
60 403470 Ny.Supi Astutik 40th √ Obgyn G4P2A1+PPM LSCS G4P2A1+PPM dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 262248 Ny.Khusnul Khotima 33th √ Obgyn 07/06/2017 G3P2A0+Post term LSCS G3P2A0+Post term dr.Umi SAB II/VK
62 403485 Ny.Risty Dwi 30th √ Obgyn 08/06/2017 G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
63 387160 Ny.Reni Aisya' 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
64 404182 Ny.Amy Suci R 27th √ Obgyn G1P0A0+KE Partial salpingectomy D G1P0A0+KE dr.Haris SAB I/VK
65 402014 Ny.Anna Chaula 43th √ Obgyn G3P2A0+PPM LSCS G3P2A0+PPM dr.Umi SAB III/VK
66 194728 Ny.Khoiriyah 64th √ Umum Fistula perianal Fistulectomy Fistula perianal dr.Bambang SAB I
67 403995 Ny.Nanik Indrawati 36th √ Umum FAM Excisi FAM dr.Bambang masker I/TC
68 403898 Tn.Ngatemo 81th √ Umum HIL residif Herniotomy+appendictomy HIL residif dr.Hernowo SAB III
69 384595 Sdr.M.Hilman 17th √ Umum Appendik perforasi Laparatomy+appendictomy Appendik perforasi dr.Hernowo SAB II
70 404123 Nn.Indri Putri 19th √ Ortho Refraktur clavicula Aff plate+orif plating Refraktur clavicula dr.Danang intubasi II/TC
71 347229 Tn.Agus Rawan 64th √ Urologi BPH TUR prostat BPH dr.Kristianto SAB II/TC
Bedah Partial aurius auricle S Rekrontruksi aurius S repair Partial aurius auricle S
72 404281 Tn.Satuman 65th √ plastik vulnus appertum lip sup lip vulnus appertum lip sup dr.Ariek intubasi II
73 398397 Ny.Elisa Eka S 26th √ Obgyn 09/06/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
74 403389 Ny.Ana Setyowati 31th √ Obgyn G1P0A0+post KLL LSCS G1P0A0+post KLL dr.Kery SAB II/VK
75 404308 Tn.Mudhar 54th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Sukarno SAB II
76 399243 Ny.Puji Wahyu W 37th √ Obgyn G2P1A0+Letlin LSCS G2P1A0+Letlin dr.Umi SAB III/VK
77 288002 Tn.Sudarmadji 70th √ Umum HIL residif Herniotomy HIL residif dr.Bambang SAB I
78 190026 Tn.Ir.Kusnadi 54th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
79 404105 Ny.Ratna W 20th √ Umum FAM Excisi FAM dr.Hernowo masker I
80 325372 Ny.Liyanatus S 28TH √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 397552 Ny.Nur Sholikah 29th √ Obgyn 09/06/2017 Abortus incomplit Curetage Abortus incomplit dr.Umi SAB II/VK
82 404356 Ny.Putri Indayani 24th √ Obgyn G1P0A0+KPP LSCS G1P0A0+KPP dr.Umi SAB II/VK
83 385864 Ny.Daesy W 24th √ Obgyn 10/06/2017 G2P0A1+kepala floating LSCS G2P0A1+kepala floating dr.Heru B SAB VVIPB
84 398080 Ny.Allysa Diandra 27th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Kery SAB III/VK
85 402969 Tn.Triona 58th √ Ortho Cl fr tibia post plating Aff plate Cl fr tibia post plating dr.Hari C masker III
86 224744 Tn.Noer Ahmad 63th √ Umum Ulcus pedis D Necrotomy+debridement Ulcus pedis D dr.Hernowo SAB VVIPB

87 326040 Tn.Sahir 53th √ Ortho Osteomilitis radius S Squestrectomy+debridement Osteomilitis radius S dr.Danang TIVA II
88 404399 Ny.Usiawati 28th √ Obgyn Mola hidatidosa Curetage Mola hidatidosa dr.Kery SAB II/VK
89 373492 Ny.Ismiatun 30th √ Obgyn 12/06/2017 G2P1A0+haemoroid LSCS G2P1A0+haemoroid dr.Umi SAB II/VK
90 401475 Ny.Aini Kusuma 34th √ Obgyn G2P1A0+varises vagina LSCS+MOW G2P1A0+varises vagina dr.Umi SAB I/VK
91 402742 Ny.Iqomatun N 26th √ Obgyn GIP0A0+letsu LSCS GIP0A0+letsu dr.Kery SAB I/VK
92 220511 Tn/Shafeii 77th √ Umum Perianal abses Incisi+debridement Perianal abses dr.Hernowo SAB II
93 321917 Ny.Lauwjangshio 47th √ Umum Mamae abrsn Excisi Mamae abrsn dr.Hernowo masker II
94 393255 Ny.Vivit Alfiyah 27th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
95 273214 Ny.Evi Andriyani 37th √ Obgyn G2P1A0+IUFD LSCS G2P1A0+IUFD dr.Umi SAB II/VK
96 402971 Ny.Eka Puji W 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
97 213019 Ny.Nurul Isnaeni 29th √ Obgyn G2P1A0+KPP LSCS G2P1A0+KPP dr.Umi SAB II/VK
98 403749 An.Amanda A 11th √ Umum 13/06/2017 Hemangioma pipi Excisi Hemangioma pipi dr.Sukarno intubasi II
99 404476 Ny.Hj.Zulaikah 61th √ Umum Ulkus pedis Debridement Ulkus pedis dr.Sukarno SAB II
KETERANGAN :
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
100 397955 Ny.Susilowati 32th √ Obgyn 13/06/2017 G4P1A2+BSC LSCS G4P1A2+BSC dr.Kery SAB II/VK
101 297499 Ny.Mariati Ningsih 37th √ Obgyn G3P1A0+BSC LSCS G3P1A0+BSC dr.Umi SAB I/VK
102 351365 Ny.Nikmatus Zulfa 28th √ Obgyn G3P1A0+BSC LSCS G3P1A0+BSC dr.Kery SAB II/VK
103 388530 Ny.Nur Alfiah 27th √ Obgyn Post curet menometrorargia Curetage Post curet menometrorargia dr.Kery SAB III/VK
104 177664 Ny.Ike Munika 33th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Hernowo SAB VIP
105 403704 Tn.Khoirul Malik 32th √ Urologi Varicocle Vasoligasi tinggi palomo Varicocle dr.Kristianto SAB III/TC
106 200781 Ny.Silvia Sri S 67th √ Ortho Lumbal kanalstenosis L4-L5 Laminectomy+stabilisasi Lumbal kanalstenosis L4-L5 dr.Larona intubasi PAV
G1P0A0+fetal
107 386274 Ny.Ina Kusuma 25th √ Obgyn G1P0A0+Fetal distress LSCS+Miomectomy distress+mioma uteri dr.Heru B SAB II/VK
108 404646 Ny.Ana Asluka 25th √ Obgyn 14/06/2017 G1P0A0+high miopi LSCS G1P0A0+high miopi dr.Haris SAB II/VK
109 404644 Ny.Astri Rosmanti 29th √ Obgyn G1P0A0+high miopi LSCS G1P0A0+high miopi dr.Haris SAB I/VK
110 399774 Ny.Widya Desti K 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB I/VK
111 404454 Tn.Sukanan 63th √ Umum Celilitis +DM Debridement Celilitis +DM dr.Sukarno SAB I
112 404387 Ny.Elia Rosida 32th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB II/VK
113 34166 Ny.Yuni Wijayanti 32th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB III/VK
114 404645 Ny.Sulaminingsih 36th √ Obgyn G5P3A1+Varises vagina LSCS+MOW G5P3A1+Varises vagina dr.Haris SAB II/VK
√ Cistoma ovarii
115 404359 Ny.Maulina 34th Obgyn infeksi+anemia SOS+Tubectomy TOA dr.Kery SAB III/VK
116 261142 Ny.Ismiati 36th √ Obgyn G9P6A2+IUFD Curetage G9P6A2+IUFD dr.Kery SAB III/VK
117 404526 Ny.Homsatun 33th √ Umum FAM Exterpasi FAM dr.Sukarno masker I
118 404527 Ny.Siti Alifah 26th √ Umum Lipoma punggung Excisi Lipoma punggung dr.Hernowo masker I
119 349521 Ny.Agustib 33th √ Obgyn G2P1A0+PRM LSCS G2P1A0+PRM dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI

120 270807 Ny.Yuni Kurnia 28th √ Obgyn 14/06/2017 G4P2A1+BSC LSCS G4P2A1+BSC dr.Umi SAB II/VK

121 390484 Nur As'adah 47th √ Obgyn G2P1A0+letsu LSCS G2P1A0+letsu dr.Umi SAB II/VK

122 220911 Ny.Nining R 33th √ Obgyn 15/06/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

123 339820 Ny.Nailul Iffah K 23th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

124 401570 Ny.Siti Maisaroh 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

125 375191 Ny.Sholikhatin 42th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK

126 404578 Ny.Sholikah 42th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Sukarno SAB III

127 402243 Ny.Yanis Fitri A 26th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Umi SAB II/VK
128 401290 Ny.Siti Munawaroh 42th √ Obgyn G2P1A0+BSC LSCS+MOW G2P1A0+BSC dr.Umi SAB III/VK

129 389078 Ny.Susilowati 40th √ Obgyn G2P1A0+PER LSCS G2P1A0+PER dr.Umi SAB II/VK

130 359980 Ny.Yuyun Wibawati 34th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Haris SAB II/VK

131 286144 Ny.Rita Rachmawati 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

132 404542 Sdr.Sukiyan 31th √ Umum Tu pedis Excisi Tu pedis dr.Hernowo SAB II

133 399230 Ny.Novianti 31th √ Obgyn G2P1A0+CPD LSCS G2P1A0+CPD dr.Kery SAB III/VK

134 369340 Tn.Sunarto 43th √ Umum Haemoroid G IV Haemoroidectomy Haemoroid G IV dr.Hernowo SAB PAV

135 058540 Nn.Indrawati 22th √ Umum FAM Excisi FAM dr.Bambang masker II/TC

136 376594 Ny.Nur Musthofiyah 47th √ Umum Perianal abses Incisi+debridement Perianal abses dr.Bambang SAB II

137 404466 Tn.Sumadi 48th √ Umum Appendicitis perforasi Appendictomy Appendicitis perforasi dr.Hernowo SAB III
Broncopneumenia gagal Broncopneumenia gagal
138 395007 An.Gilang Putra 6bln √ Umum infus Vena secsi infus dr.Sukarno LA III/PICU
139 401468 Nyu.Yulian 27th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Umi SAB II/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
G1P0A0+PRM+ket
140 364460 Ny.Sailatul I 25th √ Obgyn 16/06/2017 G1P0A0+PRM LSCS mekoneal dr.Kery SAB I/VK
141 404605 Tn.Suwandi 52th √ Umum Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno masker II
142 253849 Ny.Eni Yuliati 33th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
143 270852 Ny.Lusi Anggraeni 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
144 317225 Tn.Ribadi 61th √ Umum HIL Herniotomy Herniotomy dr.Hernowo SAB III
145 404349 Ny.Turma Zusana 69th √ Umum Cholelitiasis Cholesistectomy Cholesistectomy dr.Hernowo SAB III
146 198462 Ny.Apridita K 37th √ Obgyn G4P2A1+BSC LSCS+MOW LSCS+MOW dr.Umi SAB II/VK
147 194267 y.Kurnia Andriani 30th √ Obgyn G3P1A1+post miomectomy LSCS LSCS dr.Kery SAB II/VK
148 028002 Ny.Ditya M 29th √ Obgyn Kehamilan ektopik Salpingectomy Salpingectomy dr.Kery SAB II/VK
149 404883 Ny.Daimah 39th √ Obgyn 17/06/2017 G3P2A0+ketuban minim LSCS+MOW LSCS+MOW dr.Heru B SAB III/VK
150 391191 Ny.Varina Novita 28th √ Obgyn G2P1A0+BSC LSCS+MOW LSCS+MOW dr.Kery SAB II/VK
151 402265 Ny.Leni Dwi S 31th √ Obgyn G3P2A0+PP LSCS LSCS dr.Kery SAB II/VK
152 404906 Ny.Afrida Kurniasari 37th √ Obgyn G3P2A0+BSC LSCS+MOW LSCS+MOW dr.Kery SAB I/VK
153 295374 Ny.Iin Indriani 32th √ Obgyn G2P1A0+BSC LSCS LSCS dr.Kery SAB I/VK
154 390662 Nn.Jihan Meidy 18th √ Ortho Ganglion carpi Excisi Excisi dr.Danang SAB I/TC
155 404903 Ny.Warti 62th √ Ortho Cl fr femur Orif plating Orif plating dr.Hari C SAB III
156 397942 Ny.Nurul K 31th √ Obgyn 18/06/2017 G2P1A0+BSC LSCS LSCS dr.Umi SAB III/VK
157 326149 Ny.Kiki Febrina 24th √ Obgyn Abortus incomplit Curretage Curretage dr.Kery SAB III/VK
158 254233 Ny.Choiritun 37th √ Obgyn G3P1A1+BSC LSCS LSCS dr.Umi SAB II/VK
159 404049 Tn.Hariyanto 54th √ Umum HIL Herniotomy Herniotomy dr.Hernowo SAB I
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
160 405006 Ny.Ayu Wahyu K 27th √ Obgyn 18/06/2017 G2P1A0+NST non reaktif LSCS G2P1A0+NST non reaktif dr.Umi SAB II/VK
161 405008 Ny.Dwi Susanti 34th √ Obgyn G3P2A0+PEB+BSC LSCS G3P2A0+PEB+BSC dr.Umi SAB I/VK
162 404284 Ny.Dyah Larasati 34tth √ Obgyn G2P1A0+NST non reaktif LSCS G2P1A0+NST non reaktif dr.Umi SAB II/VK
163 392366 Ny.Rani Pratiwi 33th √ Obgyn G3P2A0+KIFL+BSC LSCS+MOW G3P2A0+KIFL+BSC dr.Umi SAB I/VK
164 403782 Ny.Myrna Rahdian 36th √ Obgyn 20/06/2017 G3P1A1+BSC LSCS+MOW G3P1A1+BSC dr.Kery SAB II/VK
165 374557 Ny.Novita Farianti 24th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
166 403594 Tn.Minto 42th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II
167 222142 Ny.Betty Ulfa 38th √ Obgyn G7P3A3+gemelli LSCS G7P3A3+gemelli dr.Kery SAB I/VK
168 305181 Ny.Dewi Astriani 30th √ Obgyn G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Kery SAB II/VK
169 404321 Ny.Maryati 43th √ Obgyn Mioma Uteri SVH+SOS Mioma uteri+cistoma ovarii dr.Kery SAB II/VK
170 355297 An.Ainur Rokhim 11th √ Ortho Cl fr humerus post plating Aff plate Cl fr humerus post plating dr.Hari C masker III
171 404915 Ny.Rina Fatmawati 27th √ Obgyn G2P1A0Z+BSC LSCS G2P1A0Z+BSC dr.Umi SAB II/VK
172 396918 Ny.Ilut Sukma 38th √ Obgyn G3P2A1+BSC LSCS+MOW G3P2A1+BSC dr.Umi SAB I/VK
173 400862 Ny.Hermin Nur 26th √ Obgyn 21/06/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
174 272738 Ny.Ida Yanti 32th √ Obgyn G4P1A2+Letsu LSCS G4P1A2+Letsu dr.Kery SAB II/VK
175 405177 Ny.Ike Puspitasari 33th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK
176 391490 Ny.Nur Tri S 22th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
177 404961 Ny.Tri Agustin 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
178 270673 Ny.Kowiliyah 31th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Haris SAB III/VK
179 385622 Ny.Enik Susilowati 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
180 094975 Ny.Puji Astutik 40th √ Obgyn 21/06/2017 G5P2A2+PP marginalis LSCS+MOW G5P2A2+PP marginalis dr.Umi SAB III/VK
181 204792 Ny.Irfani Septiani 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
182 405154 Ny.Emi Novianti 25th √ Umum Appendicitis perforasi Appendictomy Appendicitis dr.Sukarno SAB PAV
√ Obgyn Salpingectomy Cistoma ovarii dr.Umi
183 405236 Sdr.Tri Efendi 35th √ Umum 22/06/2017 HIL Herniotomy HIL dr.Hernowo SAB II/TC
184 381655 Ny.Indah Lestari 24th √ Obgyn G1P0A0+Haemoroid G III LSCS G1P0A0+Haemoroid G III dr.Umi SAB I/VK
185 405122 Ny.Eli Zairina 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
186 208476 Ny.Nurul Fauziah 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
187 405132 Ny.Miftakhul Jannah 35th √ Obgyn G5P2A2+letlin LSCS+Insersi IUD G5P2A2+letlin dr.Umi SAB I/VK
188 405277 Sdr.M.Awaludin 24th √ Ortho Cl.Dislokasi shouldier Reposisi Cl.Dislokasi shouldier dr.danang TIVA III
189 405157 Tn.Jumilan 40th √ THT Polip Nasal polip Extraksi Polip Nasal dr.Noer Sofi Intubasi III
190 401475 Ny.Aini Kusumah 34th √ Obgyn HPP + Acreta plac Hysterectomy HPP + Acreta plac dr.Umi SAB II/VK
191 405337 Sdr.Rochman T 22th √ Ortho 23/06/2017 cl.fr.dislokasi elbow Re[posisi cl.fr.dislokasi elbow dr.danang TIVA II/TC
192 346082 Ny.U'us Lailatul 26th √ Obgyn G1P0-0 + letsu LSCS G1P0-0 + letsu dr.Umi SAB II/VK
193 403996 Ny.Khoirun Nisa' 31th √ Obgyn 24/06/2017 G2P1-1 + Placenta previa LSCS G2P1-1 + Placenta previa dr.Kery SAB II/VK
194 405410 Ny.retno Wulandari 32th √ Obgyn 25/06/2017 G2P1-1 +KPP LSCS G2P1-1 +KPP dr.Haris SAB I/VK
195 402386 Ny.Ema Yuni S 31th √ Obgyn G3P1-1A1 + PPI+BSC LSCS G3P1-1A1 + PPI+BSC dr.Haris SAB III/VK
196 405457 Nn.Syfa Syafira 25th √ Umum 26/06/2017 Abces coli Incisi limpadenitis abces coli dr.Sukarno TIVA II
197 378668 Ny.Siti nurhasanah 33th √ Obgyn 27/06/2017 G2P1-1 + PRM LSCS G2P1-1 + PRM dr.Kery SAB II/VK
198 403471 Ny.Luluk khuriyah 27th √ Obgyn G1P0-0 +letak lintang LSCS G1P0-0 +letak lintang dr.Kery SAB II/VK
199 405331 Ny.Eka Dian safitri 32th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
200 315825 Ny.Intan Syahniar 38th √ Obgyn G2P1-1 + Gemeli LSCS + MOW G2P1-1 + Gemeli dr.Kery SAB VVIPA
201 185143 Ny.Izna zakiyah 37th √ Obgyn 28/06/2017 G2P1-1 + PEB LSCS G2P1-1 + PEB dr.Kery SAB I/VK
202 395205 Ny.Dewi Andayani 40th √ Obgyn G3P2-2 APB+PP totalis LSCS + MOW G3P2-2 APB+PP totalis dr.Kery SAB III/VK
203 405556 An.Fachri Anggara 6bln √ Umum Invaginasi celo caecall Laparatommy Invaginasi celo caecall dr.Sukarno Intubasi II
204 405024 Ny.Putri Dewi 24th √ Obgyn G1P0-0 + PRM LSCS G1P0-0 + PRM dr.Kery SAB III/VK
205 297108 Ny.Afiyah dewi S 25th √ Obgyn G1P0-0 + Post myoma LSCS G1P0-0 + Post myoma dr.Kery SAB II/VK
206 334814 Ny.Anik kasfiyah 36th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Haris SAB II
207 204799 Ny.Farida nur aini 35th √ Obgyn 29/06/2017 G2P1-1 +PRM+BSC LSCS G2P1-1 +PRM+BSC dr.Kery SAB I/VK
Modified Radikal
208 402408 Ny.Askun 44th √ Umum 30/06/2017 Ca.Mamae Mastectomi Ca.Mamae dr.Hernowo Intubasi I
G1P0-0 + G1P0-0 +
209 404498 Ny.Fatimah shanaz 23th √ Obgyn Oligohidramnionmm LSCS Oligohidramnionmm dr.Umi SAB VVIPA
210 404480 Ny.Sri Andayani 28th √ Obgyn G2P1-1 + BSC LSCS + IUD G2P1-1 + BSC dr.Umi SAB II/VK
211
212
213
214
215
216
217
218
219
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JUNI TAHUN 2017

KLASSIFIKASI
UMUR DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI ANAST
KH B S K ISASI POST OP OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
3/I √ √ √

2/I √ √ √

3/II √ √ √

3/I √ √ AIA
1/I √ √ √

2/I √ √ √

4/I √ √ √

3/II √ √ √
2/II √ √ √
3/III √ √ √

2/II √ √ √

3/II √ √ √

2/I √ √ √

3/II √ √ √
3/I √ √ √

2/II √ √ √

4/I √ √ √

1/I √ √ √

2/II √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

2/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/I √ √ √
2/I √ √ √

3/II √ √ √

3/III √ √ √

2/II √ √ JAI
1/I √ √ ASTRA
MEDIKA

1/II √ √ √

3/III √ √ RBH
2/III √ √ √

3/IV √ √ √
JASA
4/I √ √ RAHARJ
A

1/I √ √ √

2/I √ √ √

3/I √ √ √
YANKES
3/II √ √ TELKO
M
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

2/II √ √ √

2/III √ √ √

2/IV √ √ √

1/III √ √ √

2/IV √ √ √

3/IV √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √

3/II √ √ √

1/I √ √ √

3/III √ √ √

2/II √ √ PAKET

2/III √ √ √
3/IV √ √ √
3/III √ √ √
2/IV √ √ √

3/IV √ √ √
3/V √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/V √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

1/I √ √ √

3/III √ √ √

2/III √ √ √

1/II √ √ √

4/I √ √ √

2/III √ √ √
4/II √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

3/II √ √ √

1/II √ √ √

3/II √ √ √

2/II √ √ √

1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

2/V √ √ √
in
3/I √ √ health
garda
2/I √ √ medika

4/I √ √ √

1/II √ √ √

2/III √ √ √

2/II √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/II √ √ √

4/I √ √ √

3/III √ √

3/I √ √ √

4/II √ √ √

3/IV √ √ √

1/I √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

1/I √ √ comfeed
2/I √ √ √

4/I √ √ pertamina
3/II √ √ √

3/III √ √ √

4/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

2/II √ √ jai
3/II √ √ √

2/III √ √ √
3/IV √ √ √

4/II √ √ √

4/III √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

3/IV √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

2/II √ √ comfeed
1/I √ √ RBH
4/I √ √ hanwa
4/II √ √ √

3/III √ √ √

2/III √ √ √

2/IV √ √ √

1/II √ √ √

3/II √ √ jai
1/III √ √ √

2/IV √ √ japfa
1/III √ √ √

2/IV √ √ √

1/V √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

1/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

4/I √ √ pertamina
3/III √ √ √

2/II √ √ √

2/III √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

3/III √ √ √

3/IV √ √ √

2/II √ √ √

4/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/III √ √ √

3/III √ √ √

3/IV √ √ √

2/IV √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

3/II √ √ √

2/II √ √ √

3/III √ √ √

4/I √ √ √

3/III √ √ √
2/I √ √ √

3/II √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ √

2/II √ √ √

3/II √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

2/III √ √ √

1/II √ √ √
2/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

4/I √ √ √

2/II √ √ RBH
1/II √ √ √
BPJS
KETEN
4/I √ √ AGAK
ERJAA
N
3/I √ √ √

2/I √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

2/I √ √ √

3/I √ √ paket
1/I √ √ √

2/II √ √ √

3/II √ √ √

2/III √ √ √

3/I √ √ √

2/I √ √ √
in
3/I √ √ health
2/II √ √ √
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA


EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

JDWL OP KAT. LUKA OP BIAYA

EL CY B BK K KTR U BPJS As.


Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 404492 Ny.Utmiyati 48th √ Umum 01/07/2017 Tu mamae Excisi Excisi dr.Sukarno masker I
2 405749 Ny.Tri Susilowati 40th √ Umum Appendicitis acut Appendictomy Appendictomy dr.Hernowo SAB VVIPA

3 262963 Ny.Alqia Nur A 25th √ Obgyn G1P0A0+PROM LSCS LSCS dr.Umi SAB II/VK
4 297489 Ny.Beti Suci R 33th √ Obgyn G3P2A0+BSC LSCS LSCS dr.Umi SAB II/VK
5 401998 Ny.Umi Kulsum 32th √ Obgyn G2P1A0+BSC LSCS LSCS dr.Umi SAB II/VK
Vulnus appertumantebrachi Debridement+eksplorasi+re Debridement+eksplorasi+re
6 405768 Tn.Eko Widodo 48th √ Ortho susp ruptur tendon pair pair dr.Danang intubasi III/TC
7 405799 Ny.Miftakhul J 43th √ Obgyn 02/07/2017 G4P2A2+BSC LSCS LSCS dr.Umi SAB II/VK
8 405797 Ny.Fepi Ulfatmida 26th √ Obgyn G2P0A1+letsu LSCS LSCS dr.Umi SAB III/VK
9 265508 Ny.Meri Natalia 46th √ Obgyn Abortus incomplt Curetage Curetage dr.Umi SAB I/VK
10 405818 Ny.Nur Aini 32th √ Obgyn G2P1A0+BSC LSCS LSCS dr.Umi SAB I/VK
11 225512 Ny.Emil Agustina 38th √ Ortho 03/07/2017 Cl fr femur1/3 D Orif plating Cl fr femur1/3 D dr.Danang SAB VVIPB

12 360044 An.M.Irsyadu 13th √ Ortho Cl fr tibia fibila post plating Aff plate Cl fr tibia fibila post plating dr.Danang SAB VVIPB

13 327944 Ny.Nurahayu 39th √ Obgyn G5P2A2+PEB LSCS+MOW LSCS+MOW dr.Umi SAB I/VK
G1P0A0+CPD+uterus
14 387224 Ny.Putri Devianti 26th √ Obgyn G1P0A0+CPD LSCS bicornu dr.Umi SAB III/VK
15 281728 Ny.Istiani 33th √ Obgyn G3P2A0+BSC LSCS LSCS dr.Umi SAB II/VK
16 405913 Nn.Dina Dwi 15th √ Umum 04/07/2017 Lipoma punggung Exterpasi Exterpasi dr.Sukarno III
17 260410 Ny.Endang S 31th √ Obgyn G3P2A0+BSC LSCS+MOW LSCS+MOW dr.Kery SAB II/VK
18 405910 Tn.Siswoko 56th √ Umum HIL Herniotomy Herniotomy dr.Sukarno SAB II/TC
19 389203 Ny.Endang F 39th √ Obgyn G3P0A2+NST non reaktif LSCS LSCS dr.Umi SAB II/VK

20 405872 Tn.Suhartono 51th √ Umum HIL Herniotomy Herniotomy dr.Sukarno SAB II/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 389707 Ny.Urifah 36th √ Obgyn 04/07/2017 G3P1A0+BSC LSCS G3P1A0+BSC dr.Kery SAB II/VK
22 247378 Ny.Retno Widaryanti 40th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB I/TC
23 404391 An.Az Zahra N 10th √ Umum Atheroma femur Excisi Atheroma femur dr.Hernowo masker II
24 403195 Ny.Siti Zhuriyag 31th √ Obgyn G1P0A0+partus kasep LSCS G1P0A0+partus kasep dr.Kery SAB III/VK
25 208648 Ny.Dewi Prihastuti 25th √ Obgyn 05/07/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
26 406091 Ny.Suliha 30th √ Obgyn G3P2A0+PROM LSCS G3P2A0+PROM dr.Umi SAB III/VK
27 349193 Ny.Dewi Retno 38th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Kery SAB II/VK
28 405918 Tn.Ibrahim 48th √ Umum Abses cruris Multuole cruris Abses cruris dr.Hernowo SAB II
29 405858 Ny.Indah Yuliani 42th √ Umum Hernia sikratikalis Herniotomy Hernia sikratikalis dr.Hernowo SAB I
30 402042 Ny.Lina Ilaikun 33th √ Umum Struma Sub total lobectomy Struma dr.Hernowo intubasi II
31 405013 Nn.Putri Ramadani 23th √ Umum Tu mamae Incisi biopsi Tu mamae dr.Hernowo masker I
32 406005 Ny.Suparsi 44th √ Umum FAM Exterpasi FAM dr.Sukarno masker II/TC
33 405080 Tn.Sugianto 45th √ Umum Appendik akut Appendictomy Appendik akut dr.Sukarno SAB II/TC
34 405523 Tn.Petrus Setya 34th √ Umum Haemoroid G IV Haemoroidectomy Haemoroid G IV dr.Sukarno SAB II
35 306727 Nn.Idainin 18th √ Ortho Union fr femur post plating Remoral Union fr femur post plating dr.Danang SAB PAV
36 393115 Ny.Harnis M 33th √ Obgyn 06/07/2017 G3P1A1+BSC LSCS G3P1A1+BSC dr.Heru B SAB II/VK
37 212657 Ny.Christin Natalia 20th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB VVIPA

38 319199 Ny.Linda Fitria 30th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK
39 309470 Ny.Jamiun Nadifah 31th √ Obgyn G2P1A0+PPT LSCS G2P1A0+PPT dr.Kery SAB III/VK
40 406122 Nn.Advensia Yesie 16th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Bambang intubasi I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 406146 Nn.Anggraeni S 16th √ Umum 06/07/2017 Tu pedis Excisi Tu pedis dr.Bambang SAB II
42 322073 Tn.Mahmud 56th √ Umum Tu punggung Excisi Tu punggung dr.Hernowo SAB I
43 344725 An.Zaidan Mozarf 13th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
44 360446 Ny.Siti Sri W 28th √ Urologi Strictur uretra Sache Strictur uretra dr.Kristianto SAB II
45 000772 Sdr.M.Riyanto 25th √ Ortho Union fr tibia post plating Aff plating Union fr tibia post plating dr.Danang SAB II/TC
46 404776 Ny.Rizka Cahya 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
47 316409 Ny.Ade Irma 24th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB I/VK
48 406219 Ny.Eris Putri 26th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB II/VK
49 389705 Ny.Vanesia Ayu 27th √ Obgyn G1P0A0+nst non reaktif LSCS G1P0A0+nst non reaktif dr.Umi SAB II/VK
Cistoma ovarii+perlengketan
50 011120 Ny.Ika Sri Wahyu 35th √ Obgyn Cistoma ovarii SOS+adesiolysis uterus,omentum,colon dr.Umi SAB II/VK
51 405914 Ny.Dwi Wahyu 34th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Umi SAB III
52 165279 Tn.Widodo 47th √ THT Septum deviasi Septoplasty+turbinoplasty Septum deviasi dr.Noer S intubasi PAV
53 400147 Sdr.Anang Santoso 33th √ Umum 07/07/2017 Multuple ganglion Excisi Multuple ganglion dr.Sukarno masker I
54 405162 Ny.Novia Yetti 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB I/VK
G1P0A0+haemoroid+ketuba
55 000350 Ny.Rina Widi A 27th √ Obgyn G1P0A0+haemoroid n mekoneal G1P0A0+haemoroid dr.Umi SAB I/VK
56 399795 Ny.Lailatul Kh 35th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Umi SAB II/VK
57 394261 Ny.Sukatun 33th √ Obgyn G1P0A0+low height LSCS G1P0A0+low height dr.Umi SAB III/VK
58 404053 Ny.Tita Yulies 39th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Heru B SAB II/VK
59 400440 Ny.Admy Steimysual 44th √ Umum Tu antebrachi Excisi Tu antebrachi dr.Hernowo masker I
60 333839 Tn.Sutrisno 38th √ Umum Tu punggung Excisi Tu punggung dr.Hernowo masker III
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 243695 Ny.Yuyun Tri W 34th √ Umum 07/07/2017 Tu punggung Excisi Tu punggung dr.Hernowo masker III
62 236927 Ny.Ine Yuliana 28th √ Ortho Union fr tibia+fr humerus Aff plate Union fr tibia+fr humerus dr.Hari C intubasi II/TC
63 406299 Ny.Jumiati M 41th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
64 244076 Ny.Umi Choiroh 38th √ Obgyn G4P2A2+PP LSCS G4P2A2+PP dr.Kery SAB VVIPA

65 305122 Ny.Nur Maghfirah 32th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
66 396527 Ny.Nuril Iksyaniyah 24th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
67 403111 Ny.Ipung Liana 20th √ Obgyn 08/07/2017 G1P0A0+postdate LSCS G1P0A0+postdate dr.Kery SAB II/VK
68 406396 Ny.Budiasih 36th √ Obgyn G3P2A1+letsu LSCS+MOW G3P2A1+letsu dr.Kery SAB II/VK
69 387157 Ny.Yuliana 32th √ Obgyn G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB I/VK
70 309129 Nn.Intan Primadewi 28th √ Umum Tu kepala Excisi Tu kepala dr.Sukarno TIVA I
71 404373 Ny.Zusbaiti Latief 40th √ Umum FAM Excisi FAM dr.Hernowo TIVA I
72 299542 Ny.Fitri Ayu W 27th √ Obgyn G3P2A0+BSC LSCS+Insersi IUD G3P2A0+BSC dr.Umi SAB II/VK
73 255869 Ny.Sri Astuti C 25th √ Obgyn G2P1A0=PP LSCS G2P1A0=PP dr.Umi SAB II/VK
74 405996 Ny.Leli Maulidiyah 26th √ Umum 10/07/2017 FAM Exterpasi FAM dr.Sukarno masker III/TC
75 406050 Ny.Indah Puji 29th √ Umum FAM Exterpasi FAM dr.Sukarno masker II/TC
76 283620 Ny.Sri Mulyanti 37th √ Obgyn G4P3A1+BSC LSCS+MOW G4P3A1+BSC dr.Kery SAB II/VK
77 406310 An.M.Rifaldi 3th √ Umum HIL Herniotomy HIL dr.Bambang masker I
78 405963 Ny.Eny Lestari 40th √ Umum FCD mamae Excisi FCD mamae dr.Hernowo masker III
79 196142 Ny.Shofiyah 45th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB III/TC
80 406415 Tn.Joko Hary 37th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Hernowo SAB II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO


BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B √ K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 194941 Ny.Juwariyah 47th √ Umum 10/07/2017 HIL Herniotomy HIL dr.Hernowo SAB I
82 328974 Ny.Mafrukhah 37th √ Umum FAM Excisi FAM dr.Hernowo masker II
83 403524 Ny.Nuryaten 59th √ Umum Ca mamae Mastectomy Ca mamae dr.Hernowo intubasi III
84 202023 Ny.Dey Fita D 35th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Umi SAB II/VK
85 369718 Ny.Novie Dwi 23th √ Obgyn G2P0A1+haemoroid LSCS G2P0A1+haemoroid dr.Umi SAB II/VK
86 406494 Ny.Nirin Nisa' 41th √ Obgyn G4P3A0+BSC LSCS+MOW G4P3A0+BSC dr.Umi SAB III/VK
87 405936 Nn.Siti Nur H 15th √ Umum Hemangioma Excisi Hemangioma dr.Hernowo masker II
88 406314 Ny.Rini Fatimah 35th √ Obgyn 11/07/2017 G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB I/VK
89 406633 Ny.Usfuriati Khoriah 27th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Kery SAB II/VK
90 406545 Nn.Ade Rinda N 18th √ Umum FAM Excisi FAM dr.Sukarno masker II
91 067059 Ny.Yusi Widya N 39th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB I
92 406610 An.Alfan Sahal 12th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III
93 406314 Ny.Wiwit Arifiyani 37th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
94 406568 Ny.Novi Saita 27th √ Obgyn G2P1A0+oligohidramnion LSCS G2P1A0+oligohidramnion dr.Kery SAB III/VK
95 406300 Ny.Musaffah 54th √ Obgyn Mioma uteri SVH+Cistectomy Mioma uteri+cistoma ovarii dr.Kery SAB III/VK
96 405818 Ny.Nur Aini 32th √ Obgyn ILO post sc Debridement+reheacting ILO post sc dr.Kery SAB II/VK
97 209993 Tn.Nofi Hidayat 46th √ Umum Ganglion pedis Exterpasi Ganglion pedis dr.Sukarno LA RJ
98 267532 Nn.Septindra Yeni 23th √ Umum Tu pedis Excisi Tu pedis dr.Hernowo masker II
99 406203 Ny.Siti Pangestu 44th √ Umum Struma Sub total lobectomy Struma dr.Bambang intubasi III

KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
100 401564 Tn.Rizky Tovany 42th √ Umum 11/07/2017 Appendik akut Appendictomy Appendik akut dr.Hernowo SAB PAV
Cross injuri phalang distal Cross injuri phalang distal
101 406667 Tn.Agus Haris S 39th √ Ortho digiti I
Debridement+heacting
digiti I dr.Danang masker II/TC
102 406083 Ny.Endang Tri S 59th √ Umum Necrose digiti III pedis Amputasi+debridement Necrose digiti III pedis dr.Hernowo SAB VVIPB
103 403591 Ny.Savira Laras P 22th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
104 355853 Ny.Eka Fatmawati 35th √ Obgyn Cistoma ovarii Wedge resection ovarii S Cistoma ovarii dr.Kery SAB III/VK
105 404787 Ny.Mulikah 65th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
106 404207 Tn.Sartono 61th √ Urologi BPH Tur prostat BPH dr.Kristianto SAB VVIPA

107 332962 Ny.Sardjama'ati 59th √ Umum 12/07/2017 Tu kepala Exterpasi Tu kepala dr.Sukarno masker III
108 406659 Tn.Choirul Huda 39th √ Umum Tu gluteus Exterpasi Tu gluteus dr.Sukarno SAB II/TC
109 406220 Ny.Siti Chotimah 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
110 405039 Ny.Nuzulul Rizqiyah 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
111 406524 An.Aldarta M 13th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III
112 406235 Ny.Butyliastri S 38th √ Obgyn G4P3A0+BSC LSCS+MOW G4P3A0+BSC dr.Haris SAB I/VK
113 395306 Nn.Rinda Ayu 18th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB I
114 260265 Ny.Sila Agustiningsih 24th √ Umum Tu mamae Excisi Tu mamae dr.Hernowo masker II
115 003663 Nn.Mergirizka 19th √ Umum FAM Excisi FAM dr.Hernowo masker VVIPA
116 405582 Ny.Jumaiyah 30th √ Umum Tu mamae Excisi Tu mamae dr.Hernowo masker III
117 406214 An.M.Erwin 10th √ Ortho Cl fr radiusulna 1/3 tengah Debridement+back slab Cl fr radiusulna 1/3 tengah dr.Danang masker I
118 238865 Ny.Dwi Endah 31th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB I/VK

119 270702 Ny.Wiwik Sulastri 40th √ Obgyn G4P3A0+BSC LSCS+MOW G4P3A0+BSC dr.Umi SAB III/VK

120 343995 Ny.Anggie Citra 22th √ Obgyn G2P0A1+CPD LSCS G2P0A1+CPD dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI

BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI

121 406770 Ny.Ana Muslach 33th √ Obgyn 13/07/2017 G3P0A2+oligohidramnion LSCS G3P0A2+oligohidramnion dr.Haris SAB III/VK

122 406809 Ny.Siti Wahyuni 25th √ Obgyn G1P0A0+cistoma ovarii LSCS+SOS G1P0A0+cistoma ovarii dr.Haris SAB III/VK

123 406704 Tn.Sudarsono 40th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II

124 202395 Ny.Kiluk Andarwati 30th √ Obgyn Condiloma Couter Condiloma dr.Haris SAB I/VK

125 406780 Ny.Fitri Agustin 37th √ Umum FAM Excisi FAM dr.Bambang masker II

126 406773 Nn.Lailatul Anisa 19th √ Umum FAM Excisi FAM dr.Bambang masker II/TC
127 311354 Ny.Yeni 63th √ Umum Tu nasal Excisi Tu nasal dr.Bambang TIVA I
Lap eksplorasi,resecti Hernia ciccatric abdominalis
128 388501 Ny.Siti Mudjayana 47th √ Umum HIL ileum,end to end inkaserata dr.Bambang SAB VVIPB

129 406766 Tn.Tumijanto 47th √ Umum Appendi akut Laparatomy appendictomy Appendic akut perforasi dr.Sukarno SAB PAV

130 234361 An.Fikri Ridho 9th √ Ortho Cl fr femur 1/3 distal Orif plating Cl fr femur 1/3 distal dr.Danang SAB II

131 245329 Ny.Endah Kusuma 41th √ Umum Tu cruris Excisi Tu cruris dr.Bambang TIVA I/TC

132 406611 Tn.Hari Santoso 43th √ Urologi Silokoma penis Excisi+rekotruksi penis Silokoma penis dr.Kristianto SAB II/TC

133 406742 Ny.Siti Juwariyah 30th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Umi SAB I/VK
Menometrorargi+susp
134 400983 Ny.Shanti Cristin 40th √ Obgyn 14/07/2017 Menometrorarghi Curetage mioma uteri dr.Heru B SAB I/VK

135 249886 Ny.Deri Yanti 30th Obgyn G2P1A0+gemelli LSCS G2P1A0+gemelli DR.Kery SAB I/VK

136 360515 Ny.Lailatus Solicha 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

137 400989 Ny.Nur Istiqomah 25th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Umi SAB III/VK

138 223200 Ny.Firdausi Anida 30th √ Obgyn G1P0A0+PLR LSCS G1P0A0+PLR dr.Umi SAB II/VK
139 405888 An.Sultan M 11bln √ Urologi Phymosis Circumsisi Phymosis dr.Kristianto masker III/VK
140 275766 Ny.Wafiyah Dwi 24th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
Cl fr metacarsal Cl fr metacarsal
141 406989 Sdr.M.Abdalis 31th √ Ortho 14/07/2017 pedis+vulnus appertum Debridement pedis+vulnus appertum dr.Danang SAB II/TC
Of fr phalang prox digiti IV,V Of fr phalang prox digiti IV,V
142 330009 Tn.Budi Witono 42th √ Ortho pedis S Debridement+pining pedis S dr.Danang SAB II/TC
143 407062 Ny.Ika Yunialisa 22th √ Obgyn 15/07/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
144 366808 Ny.Maidatul H 45th √ Umum 17/07/2017 Tu lengan Excisi Tu lengan dr.Sukarno TIVA I
145 366808 Ny.Sifaul Umama 41th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
146 291993 Ny.Kiki Anggraeni 23th √ Obgyn Ruptur vagina post co Heacting Ruptur vagina post co dr.Kery SAB II/VK
147 401722 Ny.Arlinda Fitria 26th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB II/VK
148 401724 Ny.Rusdiana 29th √ Obgyn G2P1A0+letsu LSCS G2P1A0+letsu dr.Haris SAB II/VK
149 401764 Ny.Nur Fitri 27th √ Obgyn G1P0A0+KPP LSCS G1P0A0+KPP dr.Umi SAB II/VK
150 343335 Tn.Agus Joko S 46th √ Umum Tu colli Excisi Tu colli dr.Hernowo TIVA II
151 265682 Ny.Nanie Lidia K 49th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II
152 406002 Ny.Nur Laila 48th √ Umum Tu auricle Excisi Tu auricle dr.Hernowo TIVA II
Vasoligasi tinggi palomo
153 407006 Tn.Kharis Afifi 26th √ Urologi Varicocle duplex Varicocle dr.Kristianto SAB III
154 364004 Ny.Afriyah Fitriah 25th √ Obgyn G1P0A0+visus -6 LSCS G1P0A0+visus -6 dr.Kery SAB II/VK
155 405045 Ny.Camelia Novi 27th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB II/VK
156 366887 Sdr.Vrindo Mandra 26th √ Umum Struma uni nodusa Total lobectomy Struma uni nodusa dr.Hernowo intubasi II
157 406952 Tn.Samsudin 41th √ Umum Ganglion pedia Excisi Ganglion pedia dr.Bambang SAB III
158 405766 Ny.Febby Andini 23th √ Obgyn G2P1A0+high miopi LSCS G2P1A0+high miopi dr.Umi SAB III/VK
159 368076 Tn.M.Sholeh 77th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
160 405170 Ny.Siti Romlah 45th √ Umum FAM Excisi FAM dr.Hernowo masker II

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
161 309211 Ny.Galuh Rahma 28th √ Obgyn 17/07/2017 G4P1A5+BSC LSCS G4P1A5+BSC dr.Kery SAB III/VK
162 351877 Ny.Dian Puji R 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
163 285901 An.Alvero Gafriel 5th √ Umum HIL+Phymosis Herniotomy+circumcisi HIL+Phymosis dr.Hernowo masker II
164 147273 Ny.Khusnul Khotima 35th √ Obgyn Mioma uteri Miomectomy Mioma uteri dr.Umi SAB II/VK
165 400244 Nn.Alifta Firdausi 20th √ Umum 18/07/2017 FAM Exterpasi FAM dr.Sukarno masker II
166 406841 An.Akbar Rohma 8th √ Umum Ganlion carpi Exterpasi Ganlion carpi dr.Sukarno masker II
167 407175 Tn.Sujito 53th √ Umum Selulitis+DM Debridement Selulitis+DM dr.Sukarno SAB II
168 406873 Nn.Fitriana Dewi 25th √ Umum Tu supra pubis Exterpasi Tu supra pubis dr.Sukarno SAB I
169 403297 Ny.Sri Lestari 31th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB I/VK
170 406871 Tn.Moch.Dullah 53th √ Umum HIL Herniotomy HIL dr.Sukarno SAB I
171 298156 Ny.Evi Pristyawati 39th √ Obgyn Mioma uteri Miomectomy Mioma uteri dr.Kery SAB II/VK
172 404225 Ny.Ilus Ratna 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
173 406027 Ny.Suhermin 35th √ Umum Struma nodusa Sub total lobectomy Struma nodusa dr.Sukarno intubasi II
174 396683 Tn.Zainul Arifin 62th √ Umum Tu mamae Excisi Tu mamae dr.Hernowo masker II
175 406301 Ny.Sri Rahayu 55th √ Obgyn Mioma uteri SVH+SOD Mioma uter dr.Kery SAB II/VK
176 406971 Ny.Nanik Setiowati 37th √ Obgyn Molahidatidosa Curetage Molahidatidosa dr.Kery SAB II/VK
177 405955 Ny.Mairita 46th √ Urologi Ca buli buli TUR buli Ca buli buli dr.Kristianto SAB I
178 406591 Tn.M.Tofani 33th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II
179 406931 Ny.Azizatul 28th √ Obgyn G1P1A0+CPD LSCS G1P1A0+CPD dr.Umi SAB II/VK
180 407221 Ny.Dina Purwanti 32th √ Obgyn 18/07/2017 G3P1A0+PROM LSCS G3P1A0+PROM dr.Umi SAB II/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
181 390633 Ny.Sutrisni 34th √ Obgyn 19/07/2017 G3P2A0+KPP LSCS G3P2A0+KPP dr.Heru B SAB I/VK
182 344281 Tn.Hermanu S 50th √ Umum Burcitis kubiti Excisi Burcitis kubiti dr.Sukarno masker I/TC
183 346728 Ny.Suindahwati 41th √ Obgyn Polip labia mayor Exterpasi Polip labia mayor dr.Heru B SAB II/VK
184 407304 Ny.Windi Hapsari 35th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB II/VK
185 407291 Ny.Eriana Catur 38th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
186 407306 Ny.Murtiningsih 45th √ Obgyn G4P3A0+letsu LSCS+MOW G4P3A0+letsu dr.Haris SAB III/VK
187 368160 Ny.Bekti Astuti 39th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
188 406302 Ny.Yeti Ismaning 44th √ Umum Mamae abram Excisi Mamae abram dr.Hernowo TIVA II
189 406781 Nn.Annisa Hapsa 20th √ Umum FAM Excisi FAM dr.Hernowo TIVA I
190 406214 An.M.Erwin 10th √ Ortho Fr radius ulna Reposisi Fr radius ulna dr.Danang masker PAV
191 052337 Ny.Asmaniyah 58th √ Ortho Carpal tunel sindrom Release Carpal tunel sindrom dr.Danang masker I
Bedah
192 401273 Tn.Suyitno 36th √ plastik Tu manus Excisi Tu manus dr.Ariek intubasi II
193 256202 Ny.Faridah 71th √ Umum Ca mamae Modified radical mastectomy Ca mamae dr.Hernowo intubasi II
194 305406 Ny.Jamilah 40th √ Obgyn G4P2A1+PP LSCS G4P2A1+PP dr.Umi SAB II/VK
195 406690 Ny.Lina Ambarwati 22th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB I/VK
196 340144 Ny.Kasri 26th √ Obgyn G2P1A0+IUFD LSCS G2P1A0+IUFD dr.Umi SAB III/VK
197 405282 Ny.Ayu Masrucah 25th √ Obgyn G1P0A0+high miopi LSCS G1P0A0+high miopi dr.Umi SAB III/VK
198 407330 Ny.Wiwin Andriyani 28th √ Ortho Cl fr humerus Plating Cl fr humerus dr.Hari C intubasi VIP
199 207521 Ny.Sri Hariyati 30th √ Obgyn G2P1A0+KIFL LSCS G2P1A0+KIFL dr.Umi SAB II/VK
200 404264 Ny.Siti Jumaidah 41th √ Obgyn G4P3A0+letsu LSCSMOW G4P3A0+letsu dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
201 407391 Tn.Hardi Pujo 24th √ Umum 20/07/2017 Vulnus appertum ileum Explorasi laparatomy Vulnus appertum ileum dr.Sukarno SAB II/TC
202 406898 Tn.Handokao 28th √ Umum Gynocomasti Excisi Gynocomasti dr.Sukarno masker III
203 407260 Ny.Amirahmawati 33th √ Obgyn G2P1A0+letsu LSCS G2P1A0+letsu dr.Haris SAB II/VK
204 407369 Ny.Indria A 32th √ Obgyn G2P1A0+haemoroid LSCS G2P1A0+haemoroid dr.Haris SAB I/VK
205 370735 Ny.Siti Maisaroh 48th √ Umum Tu kubiti Excisi Tu kubiti dr.Sukarno masker I
206 407183 Ny.Rista Dewi 25th √ Umum FAM Exterpasi FAM dr.Sukarno masker III
207 406852 Nn.Nadia Ersa M 18th √ Umum FAM Exterpasi FAM dr.Sukarno masker II
208 262787 Ny.Rifki Norma 35h √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
209 401883 Ny.Khoiriyah 44th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
210 407381 Ny.Yuli Astutik 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
211 407393 Ny.Ade Feranti 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
212 405108 Ny.Eni Iswahyuni 48th √ Obgyn Mioma uteri SVH+SOS Mioma uteri dr.Kery SAB II/VK
213 316262 Ny.Fransisca Maria 59th √ Umum Multiple lipoma Excisi Multiple lipoma dr.Bambang masker I/TC
214 407334 Ny.Elok Suwantin 27th √ Obgyn G2P1A0+PRM LSCS G2P1A0+PRM dr.Kery SAB III/VK
215 406862 Ny.Emy Setya 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
216 407457 Ny.Yanti Agustina 33th √ Obgyn 21/07/2017 G4P3A0+BSC LSCS G4P3A0+BSC dr.Haris SAB III/VK
217 076547 Ny.Fitriyanti 38th √ Obgyn G4P3A0+PRM+BSC LSCS G4P3A0+PRM+BSC dr.Kery SAB VVIPA

218 407400 Nn.Agustin Wulan 22th √ Umum Tu lengan bawah Exterpasi Tu lengan bawah dr.Sukarno TIVA III/TC
219 250079 Ny.Sulianah 45h √ Umum Tu dinding abdomen Excisi Tu dinding abdomen dr.Hernowo TIVA II/TC
220 402930 Tn.Mustakim 62th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
221 406111 Ny.Chilmiyah 38th √ Obgyn 21/07/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
222 405211 Ny.Kusniah 58th √ Umum Ca mamae Mastectomy Ca mamae dr.Hernowo intubasi II
223 407536 Ny.Juli Eka S 27th √ Obgyn G2P1A0+prolong fase aktif LSCS G2P1A0+prolong fase aktif dr.Heru B SAB II/VK
224 241250 Ny.Siti Makmurni 46th √ Obgyn 22/07/2017 Mioma uteri SVH Multiple mioma uteri dr.Kery SAB II/VK
225 376140 Tn.H.Ismail 74th √ Umum HIL Herniotomy HIL dr.Hernowo SAB PAV
226 405076 Ny.Cicik Dwi W 29th √ Umum Struma Sub total lobectomy Struma dr.Hernowo intubasi II
Op fr phalang digit V manus Op fr phalang digit V manus
227 407452 Tn.Sukardi 46th √ Ortho D
Orif pining+debridement
D dr.Hari C masker II/TC
228 343161 Ny.Frisdyanda S 23th √ Obgyn 24/07/217 Ab incomplit+KP Curetage Ab incomplit+KP dr.Kery SAB II/VK
229 407412 Tn.Ariyanto W 29th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III
230 407502 Ny.Eky Via 27th √ Umum FAM Excisi FAM dr.Bambang masker II
231 407478 Sdr.Akbar Pratama 25th √ Umum Tu axilla Excisi Tu axilla dr.Hernowo masker II
232 018078 Sdr.M.Arsetyawan 23th √ Umum Tu pedis Excisi Tu pedis dr.Bambang SAB II
233 407508 Tn.Dedy Sutristio 31th √ Umum Haemoroid g III Haemoroidectomy Haemoroid g III dr.Bambang SAB II
234 406938 An.Haniah arya 6th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
235 406684 Ny.Masrianah 52th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Umi SAB II/VK
236 379358 Ny.Agil Novitasari 21th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
237 407680 Ny.Evi Ariani 22th √ Obgyn G4P0A3+post term LSCS G4P0A3+post term dr.Umi SAB I/VK
238 257434 Ny.Rizqi Amalia 33th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Umi SAB I
239 407764 Ny.Reni Setianingih 33th √ Obgyn 25/07/2017 G4P3A0+PROM LSCS G4P3A0+PROM dr.Umi SAB II/VK
240 295652 Ny.Yuniar Tri W 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
241 368412 Ny.Dwi Utami 40th √ Umum 25/07/2017 FAM Exterpasi FAM dr.Sukarno masker II
242 364828 Ny.Anik Candra Y 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
243 407448 Ny.Siti Nurjannah 34th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB III/TC
244 365136 Ny.Sugiyanti 29th √ Obgyn G2P1A0+letsu LSCS G2P1A0+letsu dr.Haris SAB III/VK
245 407677 Tn.Saroni 62th √ Umum Haemoroid g IV Haemoroidectomy Haemoroid g IV dr.Sukarno SAB III
246 407763 Ny.Betrice Chris 20th √ Obgyn G1P0A0+KPP LSCS G1P0A0+KPP dr.Haris SAB II/VK
247 407768 Nn.Nazilla Putri 13th √ Obgyn Hymen imperforatus Cross incisi Hymen imperforatus dr.Kery SAB II/VK
248 212111 Ny.Munadifah 46th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
249 238862 Ny.Isnaini Aluma 36th √ Obgyn Menometrorarghi Curetage Menometrorarghi dr.Kery SAB III/VK
250 246085 Ny.Hayumi Ifro 35th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
251 376733 Sdr.Akmal Taufik 17th √ Urologi Varicocle Vasoligasi tinggi palomo S Varicocle dr.Kristianto SAB I/TC
252 407855 Ny.Desi Anggraeni 23th √ Obgyn 26/07/2017 G1P0A0+KPP LSCS LSCS dr.Haris SAB II/VK
253 399847 Ny.siti Herawati 33th √ Obgyn G2IP1A0+BSC LSCS LSCS dr.Haris SAB II/VK
254 406577 Tn.Ahmad Ikhfar 53th √ Umum HIL Herniotomy Herniotomy dr.Sukarno SAB III
255 407704 Tn.Suyatno 43th √ Umum Ateroma punggung Exterpasi Exterpasi dr.Sukarno SAB III
256 276873 Tn.Usman Abdul 61th √ Umum HIL Herniotomy Herniotomy dr.Hernowo SAB I
257 407435 Tn.Irwan Amrul 31th √ Umum Haemoroid Haemoroidectomy Haemoroidectomy dr.Hernowo SAB VVIPA

258 407798 Ny.Eni Sumarlik 31th √ Obgyn G3P2A0+BSC LSCS LSCS dr.Umi SAB I/VK
259 283505 Tn.ChoirulAnam 36th √ Umum 27/07/2017 Fistula ani Fistulectomy Fistulectomy dr.Sukarno SAB II
260 407800 Ny.Suhartatik 55th √ Umum Lipoma paha Exterpasi Exterpasi dr.Sukarno SAB II
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
261 287864 Ny.Endang Siswati 26th √ Obgyn 27/07/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
262 206307 Ny.Ida Rahmawati 36th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB VVIPB
263 407940 Ny.Lia Nur F 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
264 407938 Ny.Nuzula Zulfia 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
265 404257 Ny.Lenny Fitri A 19th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Haris SAB II/VK
266 389637 Ny/Leni Erma 22th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Haris SAB II/VK
267 407868 Tn.Iksan Luduni 38th √ Umum Multiple ateroma punggung Excisi+debridement Multiple ateroma punggung dr.Hernowo TIVA II
268 407371 Ny.Siti Cholifah 59th √ Umum Hernia femoralis Herniotomy Hernia femoralis dr.Hernowo SAB III
bedah
269 175897 An.Alya Risqia 8th √ mulut Mucocle Incisi Mucocle dr.Henry TIVA VIP
270 382018 Tn.Dedy Dwianto 34th √ Umum Ganglion carpi Excis Ganglion carpi dr.Bambang masker II
271 407889 Ny.Sulasmi 47th √ Umum Tu mamae Excisi Tu mamae dr.Bambang masker III
272 366076 Ny.Wiecky Maniek 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
273 210669 Ny.Anil Fitria 37th √ Obgyn G2P1A0+post date LSCA+MOW G2P1A0+post date dr.Umi SAB III/VK
274 406352 Ny.Rasmi 42th √ Obgyn Cistoma Ovarii bilateral SOS+oovarectomy partial D Cistoma Ovarii bilateral dr.Umi SAB II/VK
275 407901 Ny.Sarinah 31th √ Obgyn G2P1A0+post term LSCS G2P1A0+post term dr.Umi SAB III/VK
276 408023 Ny.Olyvia Sandra 26th √ Obgyn G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Umi SAB I/VK
277 408010 Sdr.Nova Terna 17th √ Umum 28/07/2017 Abses paha D Incisi+debridement Abses paha D dr.Sukarno SAB II
278 389273 Tn.M.Andie 39th √ Umum Fibroma poplitea Excisi Fibroma poplitea dr.Hernowo SAB II
279 390685 Sdr.M.Fajar 23th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
280 203904 Nn.Yunifah Dwi 18th √ Umum Tu Skull Excisi Tu Skull dr.Hernowo TIVA III

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN : JULI TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
281 390264 Ny.Tantri Cristiani 27th √ Obgyn 28/07/2017 G1P0A0+letsu LSCS G1P0A0+letsu dr.Umi SAB II/VK
282 408062 Ny.Pramita 27th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB II/VK
283 405981 Ny.Endah Ragil 27th √ Obgyn G1P0A0+APB LSCS G1P0A0+APB dr.Kery SAB II/VK
284 408100 Ny.Rahayu N 25th √ Obgyn G2P1A0+kala I memanjang LSCS G2P1A0+kala I memanjang dr.Kery SAB II/VK
285 392653 Ny.Rahayu 27th √ Obgyn 29/07/2017 G1P0-0 + floating Head LSCS G1P0-0 + floating Head dr.Kery SAB II/VK
286 333229 Ny.Khofifah 66th √ Umum Hernia femoralis Herniotomy Hernia femoralis dr.Hernowo SAB III
287 404523 Tn.Widaldi 54th √ Ortho Haemoroid Gr III Haemoroidectomi Haemoroid Gr III dr.Hernowo SAB I
288 226049 Tn.Ach.Jaini 54th √ Umum Cl.Fr.Clavicula Orif Plating Cl.Fr.Clavicula dr.Hari C Intubasi II /TC
289 357324 Ny.Farida Hanum 29th √ Obgyn G2P1-1 + BSC LSCS + IUD G2P1-1 + BSC dr.Umi SAB II/VK
290 391781 Ny.Dwinur cahyani 27th √ Obgyn G2 P1-1 + BSC LSCS + IUD G2 P1-1 + BSC dr.Umi SAB II/VK
291 401517 Ny.Binti Fathiatul 40th √ Obgyn 7/31/2017 G2P1A0+KIFL LSCS G2P1A0+KIFL dr.Heru B SAB I/VK
292 407975 Nn.Dina dwi W 20th √ Umum ganglion carpi Exterpasi ganglion carpi dr.Sukarno masker III/TC
293 387693 Tn.Darman 70th √ Umum celulitis cruris Debridement celulitis cruris dr.Sukarno SAB VVIPB
294 389581 Ny.Mega wahyu 24th √ Obgyn G1P0-0 + PEB LSCS G1P0-0 + PEB dr.Umi SAB II/VK
295 408057 Sdr.Moch.Alfan 23th √ Umum Multiple lipoma Exterpasi Multiple lipoma dr.Bambang TIVA II
296 406322 Ny.Rifaus sa'diyah 46th √ Umum Hil Hernioraphy Hil dr.Hernowo SAB III
297 408048 Nn.Rizki Agustin 18th √ Umum Fam Excisi Fam dr.Bambang Masker II
298 408215 An.Subwiba rafi 10th √ Umum Combutio gr II Debridement Combutio gr II dr.Hernowo TIVA III
299 376493 Ny.Nasikah 53th √ Umum tu.Manus Excisi tu.Manus dr.Bambang Masker II
300 312281 Ny.Poniah 54th √ Umum Appendik Kronis Appendiktomy Appendik Kronis dr.Hernowo SAB III

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
301 362166 Ny.Sawati 56th √ Umum 7/31/2017 Gall stone Cholecystectomy Gall stone dr.Hernowo SAB III
302 174686 Ny.Sriyani 70th √ Umum Ulkus pedis Debridement Ulkus pedis dr.Hernowo SAB III
303 254538 Ny.Enik yuliatin 32th √ Obgyn G4 P1-1A2 + bsc LSCS G4 P1-1A2 + bsc dr.Umi SAB II/VK
304 399241 Ny.Nunung s 24th √ Obgyn G2 P1-1 + BSC LSCS G2 P1-1 + BSC dr.Umi SAB II/VK
305 391271 Ny.Tri Budianti 34th √ Obgyn G3P2A0=BSC LSCS G3P2A0=BSC dr.Umi SAB I/VK
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
2/I √ √ √

1/I √ √ √

2/II √ √ inhealth

2/III √ √ √

3/I √ √ √

4/I √ √ √

2/I √ √ √

3/I √ √ √
2/II √ √ √
2/III √ √ √

4/I √ √ √

2/I √ √ JCI
3/I √ √ √

3/II √ √ admedika
2/II √ √ √

1/I √ √ √

3/I √ √ √

3/II √ √ √

4/I √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

2/II √ √ √

2/III √ √ √

2/III √ √ JAI
3/I √ √ √

2/I √ √ √
3/II √ √ √

1/III √ √ √

3/II √ √ √

2/II √ √ √

2/III √ √ √

1/I √ √ √

1/II √ √ √

1/III √ √ √

4/I √ √ √

2/I √ √ √

3/I √ √ √

2/II √ √ √

1/I √ √ AIA
2/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

1/III √ √ √

1/II √ √ √

2/III √ √ √

4/I √ √ √

3/III √ √ √

3/IV √ √ angkasa pura


2/IV √ √ √

2/V √ √ √

3/V √ √ √

2/VI √ √ √

4/II √ √ AIA
1/I √ √ √

3/I √ √ √
2/I √ √ √
2/II √ √ √
3/II √ √ √
1/II √ √ √

2/III √ √ √
1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

4/I √ √ √

2/IV √ √ √

3/IV √ √ √

2/IV √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √
3/II √ √ √

2/II √ √ √

3/I √ √ √

2/II √ √ √

4/I √ √ √

2/II √ √ √

4/I √ √ Ramayana lestari


1/I √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

2/III √ √ √

3/IV √ √ √
3/III √ √ √

3/IV √ √ √

3/V √ √ √

4/II √ √ √

3/I √ √ √

2/III √ √ √

1/II √ √ √

4/I √ √ √

1/I √ √ √

3/II √ √ √

2/I √ √ √

3/IV √ √ √

1/II √ √ √

4/I √ √ ABDA
2/III √ √ √

4/II √ √ √

Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ Manulife
4/III √ √ √

1/IV √ √ √

2/IV √ √ √

3/II √ √ RBH
3/III √ √ √

2/V √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

2/II √ √ √

1/III √ √ √

3/II √ √ √

2/IV √ √ √

1/III √ √ √
2/II √ √ √

1/II √ √ √

4/I √ √ √

3/IV √ √ √

4/II √ √ √

4/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/I √ √ √

1/I √ √ √

1/II √ √ √

1/III √ √ √

2/III √ √ √
2/IV √ √ √

1/IV √ √ √

3/II √ √ √

4/II √ √ √

3/III √ √ Admedika
2/III √ √ √

4/II √ √ √

1/I √ √ √

3/I √ √ CAR
2/I √ √ √

2/II √ √ √

3/II √ √ √

2/III √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

4/I √ √ √

3/I √ √ √

1/I √ √ √

3/I √ √ √

1/II √ √ √

2/I √ √ √

3/II √ √ √

3/III √ √ √

1/II √ √ √

2/II √ √ √

2/III √ √ √

2/IV √ √ √

3/IV √ √ √

1/IV √ √ √

4/II √ √ √

3/VI √ √ √

1/IV √ √ √

1/V √ √ √
2/V √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/V √ √ √

4/III √ √ √

2/VI √ √ √

3/VI √ √ √

4/I √ √ √

1/I √ √ √

1/III √ √ Angkasa pira


1/II √ √ √

3/I √ √ √

4/II √ √ √

3/II √ √ √
2/II √ √ √

4/II √ √ √

4/III √ √ √

2/II √ √ √

1/III √ √ √

2/IV √ √ √

1/IV √ √ √

2/IV √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/I √ √ √

2/II √ √ √
3/I √ √ √

1/II √ √ √

2/III √ √ √

3/II √ √ √

2/III √ √ √

1/I √ √ √

4/I √ √ √

4/II √ √ √

2/IV √ √ √

3/III √ √ √

3/V √ √ √

3/VI √ √ Inhealth
2/V √ √ √

4/III √ √ √

2/IV √ √ √

1/III √ √ √

1/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

4/II √ √ √

4/I √ √ √

1/II √ √ √

2/II √ √ √

3/II √ √ √

2/I √ √ √

1/IV √ √ √

2/IV √ √ √

2/V √ √ √

3/IV √ √ √

2/IV √ √ √
3/I √ √ √

2/I √ √ √

1/I √ √ RBH
2/II √ √ √

1/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

2/III √ √ √

2/IV √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

4/I √ √ √

1/I √ √ √
2/I √ √ RBH
1/II √ √ √

4/I √ √ √

2/II √ √ √

1/II √ √ √

2/III √ √ √

2/IV √ √ √

3/II √ √ √

3/III √ √ √

2/IV √ √ √

2/I √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √

3/I √ √ √

4/I √ √ √

2/II √ √ √

1/II √ √ √

2/III √ √ √

2/IV √ √ √

3/III √ √ √

1/II √ √ SIMAS
3/I √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √

1/II √ √ √

3/II √ √ √

1/I √ √ Equity
2/III √ √ √

1/I √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ JAI
3/I √ √ √

3/II √ √ √

2/III √ √ √

4/I √ √ √

4/II √ √ √

1/II √ √ √

2/III √ √ √

4/I √ √ AIA
4/II √ √ √

4/III √ √ √

3/III √ √ √
2/IV √ √ AIA
3/IV √ √ √

2/V √ √ √

3/V √ √ √

1/I √ √ √

1/II √ √ √

2/I √ √ √

1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/II √ √ √

2/II √ √ √

3/II √ √ √
2/II √ √ √

1/I √ √ √

1/II √ √ √
Lippo
4/I √ √ general

2/II √ √ √

3/III √ √ √
mega
admedi
2/I √ √ ka

2/II √ √ √

1/I √ √ √

3/I √ √ √

4/I √ √ √

2/I √ √ √

4/II √ √ √

I/IV √ √ √

4/I √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ √

1/III √ √ √

3/IV √ √ √

4/III √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 408326 Ny.Wahyu Ningsih 29th √ Obgyn 01/07/2017 G2P1A0+PROM LSCS G2P1A0+PROM dr.Umi SAB II/VK
2 402103 Ny.Paramita Sari 26th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK

3 315394 Ny.Yeni Ayu T 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
4 256655 Ny.Dewi Narti 35th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB II/VK
5 200058 Ny.Kho;idya M 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
6 254843 Ny.Keila Bela 22th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
7 407244 Ny.Elok Tri K 46th √ Obgyn Mioma Uteri SVH+SOS Mioma Uteri dr.Kery SAB II/VK
8 343812 Ny.Windra sudrajat 29th √ Obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
9 380529 Ny.Sulistyowati 30th √ Umum 02/08/2017 Ganglion Poplitea Excisi Ganglion Poplitea dr.Sukarno SAB II/TC
10 408227 Tn.Satuwir 75th √ Umum Abces Genue Debridement Abces Genue dr.Sukarno SAB III
11 382296 Ny.Peni Purwati 51th √ Umum Ca.Mamae Mastectomy Ca.Mamae dr.Sukarno Intubasi III

12 398671 Ny.yuli Ariyani 29th √ Obgyn G2 P1-1 + BSC LSCS G2 P1-1 + BSC dr.Haris SAB II/VK

13 408258 Ny.Herlina 24th √ Umum Fam Excisi Fam dr.Hernowo masker II/TC
14 407737 Ny.Sunarsih 31th √ Umum Mamae aberant Excisi Mamae aberant dr.Hernowo masker II/TC
15 408267 Tn.M.Wahyudi 36th √ Umum Tu.Pedis Excisi Tu.Pedis dr.Hernowo SAB II/TC
16 408315 Tn.Usman 62th √ Umum Abces Pedis Incisi + Debridement Abces Pedis dr.Hernowo SAB I
17 260951 Ny.Miati 58th √ Umum Gall stone Cholecystectomy Gall stone dr.Hernowo SAB II
18 408302 Tn.Patmo 34th √ Umum Hil Herniotomy Hil dr.Hernowo SAB I/TC
19 217309 Ny.Siti Sumarliya 28th √ Obgyn G1P0-0 + PROM + Kala II LSCS G1P0-0 + PROM + Kala II dr.Umi SAB II/VK

20 408477 Ny.Siti Khotijah 23th √ Obgyn Myoma Geborn LSCS Myoma Geborn dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 406966 Ny.Vivin Juwita 31th √ Obgyn 02/08/2017 Geborn mioma Miomectomy Geborn mioma dr.Umi SAB II/VK
22 362543 Ny.dr.Endah N 59th Ortho Tinger finger Release tendon Tinger finger dr.Danang masker VIP
23 392692 Ny.Chusnul C 44th √ Obgyn 03/08/2017 G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB III/VK
24 387193 Ny.Ismawati 23th √ Umum FAM Exterpasi FAM dr.Sukarno masker II
25 408355 Ny.Siti Machmula 28th √ Umum Fibro lypoma paha Exterpasi Fibro lypoma paha dr.Sukarno SAB I
26 407128 Ny.Miftakhul Anis 44th √ Obgyn G5P3A1+PP LSCS+MOW G5P3A1+PP dr.Kery SAB I/VK
27 351824 Ny.Mafira Nur A 25th √ Obgyn G2P0A1+PP LSCS G2P0A1+PP dr.Kery SAB II/VK
28 408134 Ny.Lusiana 35th √ Obgyn Ciste pd folicle vagina Exterpasi Ciste pd folicle vagina dr.Kery SAB II/VK
29 408500 Ny.Corry Rimata 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB I/VK
30 406761 Ny.Lilia Rahayu 44th √ Obgyn Menometrirarghia Curetage Menometrirarghia dr.Haris SAB I/VK
31 404648 Ny.Eti Mulyani 36th √ Anestesi CKD pasang CVC CKD dr.Ary F LA I/RJ
32 403107 Ny.Paramita Angela 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB I/VK
33 408395 Tn.Suradi 56th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB III
34 408476 Ny.Sulistyorini 36th √ Umum Appendicitis Appendictomy Appendicitis dr.Bambang SAB II/TC
35 408435 Tn.Agus Tjahyono 56th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Bambang SAB I
36 341685 An.M.Hilal Ikhsani 7th √ Ortho Union fr tibia post plating Aff plate Union fr tibia post plating dr.Danang SAB II
37 407781 Ny.Wahyu Astutik 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

38 406990 Ny.Lilis Khorida 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
39 408546 Ny.Himmatul 24th √ Obgyn 04/08/2017 G1P0A0+Post date LSCS G1P0A0+Post date dr.Haris SAB II/VK
40 407803 Ny.Siti Umroh 37th √ Umum Atheroma pipi Exterpasi Atheroma pipi dr.Sukarno TIVA II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 391837 Ny.Alia Loviana 26th √ Obgyn 04/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB VVIPB

42 276370 Ny.Aukiya Mifta 29th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB I/VK
43 002391 Tn.Ainul Yaqin 36th √ Umum Multiple tu skull Excisi Multiple tu skull dr.Hernowo TIVA II
44 354413 Tn.Gorry Prananto 38th √ Umum Multiple atheroma Excisi Multiple atheroma dr.Hernowo TIVA II
45 340505 Tn.Lasini 49th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Hernowo SAB II
46 408491 Tn.Sarimin 44th √ Umum Multiple lipoma Excisi Multiple lipoma dr.Hernowo TIVA III/TC
47 303710 Ny.Siti Sudjasti 73th √ Ortho Cl fr colles Reposisi pasang gips Cl fr colles dr.Danang masker I
48 396066 Ny.Relyta Retno 26th √ Obgyn G2P1A0+haemoroid LSCS G2P1A0+haemoroid dr.Umi SAB II/VK
49 288374 Ny.Sri Sugiarti 42th √ Obgyn Polip cervik Excisi tumor Tumor portio dr.Umi SAB II/VK
50 152155 Ny.Khairun Nisak 39th √ Obgyn G3P1A0+BSC LSCS+MOW G3P1A0+BSC dr.Kery SAB I/VK
51 408470 Ny.Nurul Azizah 34th √ Obgyn 05/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
52 408554 Tn.Muslik 57th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II
53 408338 Ny.Diana Puspita 35th √ Ortho Fr clavicula post plating Aff plate Fr clavicula post plating dr.Danang masker II
54 352225 Ny.Afifah An U 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB VVIPA
55 181250 Ny.Ninik Prasetyo 42th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
56 303284 Ny.Frena Arizona 34th √ Obgyn G3P1A1+PP LSCS G3P1A1+PP dr.Umi SAB I/VK
57 407769 Ny.Suharni 31th √ Obgyn 7/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
58 393831 Ny.Tina Yuniarti 29th √ Obgyn G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Kery SAB II/VK
59 349825 Ny.Sukarti 34th √ Umum FAM Excisi FAM dr.Hernowo masker III
60 061624 Tn.M.Fasin 53th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Hernowo SAB I
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 408759 Ny.Kusni 57th √ Umum 07/08/2017 Nekrosis digiti I,II,III pedis Amputasi+debridement Nekrosis digiti I,II,III pedis dr.Hernowo SAB I
62 175598 Tn.Sugeng W 41th √ Umum CKD AV shunt CKD dr.Hernowo LA II/TC
63 301110 Ny.Putriana K 26th √ Obgyn 08/08/22017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
64 254981 Ny.Siti Sholicha 46th √ Umum FAM Exterpasi FAM dr.Sukarno masker II/TC

65 408867 Ny.Ani Yuliani 27th √ Umum Giant FAM Exterpasi Giant FAM dr.Sukarno masker II/TC
66 209681 Ny.Siti Fatima 32th √ Umum Multiple clavus Exterpasi Multiple clavus dr.Sukarno SAB II/TC
67 408823 Sdr.Dimas Restian 18th √ Umum Ulcus dada Exterpasi Ulcus dinding thorax dr.Sukarno TIVA II/TC
68 241138 Ny.Rahajeng Nuril 32th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB VVIPA
69 276147 Ny.Muflicah 35th √ Obgyn G3P2A1+BSC LSCS+MOW G3P2A1+BSC dr.Kery SAB II/VK
70 284091 Tn.Andoyo 37th √ Umum Tumor kepala Exterpasi Tumor kepala dr.Sukarno TIVA I/TC
71 001722 Nn.Adila Fatma 17th √ Umum FAM Excisi FAM dr.Hernowo masker VVIPA
72 393252 Sdr.Miftakhul F 24th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB vvipb
73 406944 Ny.Sukarti 48th √ Umum Tu supra clavicula Excisi Tu supra clavicula dr.Bambang TIVA II/TC
74 100328 Tn.Rosal Robyansa 50th √ Umum Hemangioma telinga Excisi Hemangioma telinga dr.Bambang TIVA I
75 407198 Tn.M.Bakhrun R 35th √ Urologi Varicocle Vasoligasi tinggi palomo Varicocle dr.Kristianto SAB II
76 347229 Tn.Agus Rawan 64th √ Urologi Strectur uretra Sachze Strectur uretra dr.Kristianto SAB II
77 408929 Ny.Dina Wahyu 39th √ Obgyn G3P2A1+BSC LSCS+MOW G3P2A1+BSC dr.Kery SAB I/VK
78 305934 An.Ahmad Iqbal 5th √ Ortho Cl fr antebrachii Reposisi+psg gipps Cl fr antebrachii dr.Hari C masker I
79 344094 Sdr.Ahmad Yuda 20th √ Ortho Fr tibia fibula post plating Aff plate Fr tibia fibula post plating dr.Hari C SAB II
80 408894 Ny.Asrul Puspita 24th √ Obgyn G1P0A0+oligohidramnion LSCS G1P0A0+oligohidramnion dr.Heru B SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B √ K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 218544 Ny.Ling Ling P 30th √ Obgyn 09/08/2017 Cistoma Ovarii Wedge resection S+D Cistoma Ovarii dr.Kery SAB II/VK
82 390297 Ny.Erna Puji A 30th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Umi SAB II/VK
83 405846 Ny.Wanti 40th √ Obgyn G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB II/VK
84 405651 Nn.Wulan Cyntia 20th √ Umum FAM Excisi FAM dr.Hernowo Masker II/VK
85 303931 Tn.Joni 54th √ Umum Lipoma punggung Excisi Lipoma punggung dr.Hernowo SAB III
86 408836 An.Fikri Ahmad 10th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
87 232617 An.M.Ramzhan 8th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
88 212572 Ny.Nur Mujiati 46th √ Umum Appendicitsi kronis Appendictomy Appendicitsi kronis dr.Hernowo SAB PAV
89 218367 Sdr.Rizki Haidar 21th √ Umum Haemoroid G IV Haemoroidectomy Haemoroid G IV dr.Hernowo SAB VVIPA
90 336946 Ny.Lilis Suryani 39th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB I/VK
91 336680 Ny.Tutik Ningsih 29th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB III/VK
92 140027 Ny.Nur Faricha 35th √ Obgyn 10/08/2017 G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB III/VK
93 277824 Ny.Ainun Zakiyah 40th √ Obgyn G3p2a0+letsu LSCS+MOW G3p2a0+letsu dr.Kery SAB I/VK
94 406181 Ny.Oktarita Pratiwi 28th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK
95 292948 Ny.Siti Zainab 34th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Heru B SAB II/VK
96 407674 Ny.Ermawati 31th √ Obgyn Cistoma ovarii SOD+cistectomy D Cistoma ovarii dr.Kery SAB II/VK
97 401073 Ny.Suci Hervianti 36th √ Obgyn G4P3A1+BSC LSCS+MOW G4P3A1+BSC dr.Kery SAB II/VK
98 197077 Ny.Ajeng Citra 22th √ Obgyn G1p0a0+astma LSCS G1p0a0+astma dr.Kery SAB I/VK
99 409060 Ny.Kustiah 39th √ Umum Kiste ductus thyroiglosus Excisi Kiste ductus thyroiglosus dr.Bambang intubasi I/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
100 409058 Ny.Mardiyah 51th √ Umum 10/08/2017 Haemoroid G III Haemoroidectomy Haemoroid G III dr.Bambang SAB II
101 373318 Ny.Khulafatur R 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
102 408335 Ny.Indah Surya 34th √ Obgyn Polip servik Exterpasi Polip servik dr.Umi SAB II/VK
103 319789 Ny.Paryanti 41th √ Umum Tu mamae Excisi Tu mamae dr.Bambang masker III/TC
104 275975 Ny.Lia Indah 32th √ Obgyn 11/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
105 392605 Ny.Nindya Apria 26th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Heru B SAB II/VK
106 203420 Tn.Zainul Arifin 50th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II
107 408015 Ny.Sri Mulyani 37th √ Obgyn G3P1A1+KIFL LSCS G3P1A1+KIFL dr.Umi SAB II/VK
108 383749 Ny.Setyo Ningsih 23th √ Umum FAM Excisi FAM dr.Hernowo masker III
109 406808 Tn.Irwanto 37th √ Umum Tumor cruris Excisi Tumor cruris dr.Hernowo SAB II/T
110 358820 Ny.Ambar Rodita 29th √ Obgyn G4P0A3+PEB LSCS G4P0A3+PEB dr.Umi SAB II/VK
111 246086 Ny.Amenah 57th √ Umum Ca mamar Modified radical mastectomy Ca mamar dr.Hernowo intubasi II
112 227646 Ny.Yuni Prasetia 25th √ Obgyn 12/08/2017 G3P2A0+letsu LSCS G3P2A0+letsu dr.Heru B SAB III/VK
113 397011 Ny.Nonik Prasetia 26th √ Obgyn G2P1A0+PRM LSCS G2P1A0+PRM dr.Kery SAB II/VK
114 080710 An.Ragil Thufaila 12th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB VVIPB
115 409239 Ny.Hona 80th √ Ortho Fr coloum femur Total hip replisment Fr coloum femur dr.Hari C SAB III/TC
116 409113 Ny.Supiatin 61th √ Umum Celulitis pedis+DM Debridement Celulitis pedis+DM dr.Sukarno SAB I
117 409275 Ny.Atik Sulistyo 29th √ Obgyn G1P0A0+letsu LSCS G1P0A0+letsu dr.Kery SAB II/VK
118 277895 Ny.Iin Meilina 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
119 409210 Ny.Insiyatur R 22th √ Obgyn G1P0A0+letsu LSCS G1P0A0+letsu dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN JULI TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI

120 402356 Ny.Nurul Q 38th √ Obgyn 12/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

121 408656 Ny.Yuni Winarti 37th √ Obgyn 8/13/2017 G5P3A1+BSC LSCS+MOW G5P3A1+BSC dr.Umi SAB II/VK

122 344383 Ny.Evi Alfiyah 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

123 409344 Ny.Riama 46th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB III

124 408692 Ny.Retna Puji A 30th √ Obgyn 14/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK

125 397266 Ny.Ipit Solicha 37th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK

126 395562 Ny.Sonya Yuana 24th √ Obgyn G1P0A0+visus -9 LSCS G1P0A0+visus -9 dr.Kery SAB II/VK

127 409188 Tn.Mutramun 52th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
128 409295 Ny.Dewi Asih 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

129 409144 Ny.Diah Ayu S 24th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Kery SAB II/VK

130 383319 Ny.Luluk Yuliana 42th √ Obgyn Cistoma ovarii Oovarectomy partial S Cistoma ovarii dr.Umi SAB II/VK

131 409338 An.Ramzi Faiz 12th √ Ortho Cl fr radius ulna 1/3distal S Orif plating Cl fr radius ulna 1/3distal S dr.Danang intubasi III

132 409461 Ny.Sulianah 43th √ Umum 15/08/2017 Dermoid cist Exterpasi Dermoid cist dr.Sukarno TIVA II/TC

133 409430 Tn.Sutarman 49th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III/TC

134 409476 Tn.Solikin 50th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III/TC

135 342615 Tn.Suyono 55th √ Umum Perianal fistel Fistilectomy Perianal fistel dr.Sukarno SAB VVIPB

136 409031 Ny.Veronika Lilik 34th √ Obgyn G4P3A0+PP LSCS G4P3A0+PP dr.Kery SAB I/VK

137 349330 Ny.Salsabilah 24th √ Obgyn G1P0A0+myopia LSCS+Insersi IUD G1P0A0+myopia dr.Umi SAB I/VK

138 409512 Ny.Suwarni 38th √ Obgyn G3P2A0+APB LSCS+MOW G3P2A0+APB dr.Umi SAB I/VK
139 353888 Ny.Lisa Irawati 36th √ Obgyn G45P3A1+BSC LSCS+MOW G45P3A1+BSC dr.Kery SAB I/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
140 310185 Ny.Tri Widias M 33th √ Obgyn 15/08/2017 G4P1A2+BSC LSCS G4P1A2+BSC dr.Kery SAB I/VK
141 387140 Ny.Firdausi 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
142 405031 Ny.Irma Handayani 38th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
143 365060 Ny.Udaiyah 56th √ Umum Abses cruris Multiple incisi Abses cruris dr.Hernowo SAB I/TC
144 380779 Ny.Maymanah 37th √ Umum FAM Excisi FAM dr.Hernowo TIVA II
145 326104 Ny.Sumartini 49th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
146 409227 Ny.Marfuah 45th √ Umum Tumor punggung Excisi Tumor punggung dr.Bambang TIVA II
147 408844 Ny.Siti Minarni 50th √ Obgyn Polip cervik Couter Polip cervik dr.Kery SAB III/VK
148 409244 An.Alvito Dinova 14th √ Umum Tumor bibir Excisi Tumor bibir dr.Bambang TIVA II
149 409208 Ny.Siti Maryam 22th √ Umum Mamae abrant Excisi Mamae abrant dr.Bambang TIVA III
150 294907 Tn.Suparlan 69th √ Umum HIL Herniotomy HIL dr.Bambang SAB II
151 193236 Ny.Endah Hidayati 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
152 409515 Tn.Sadi 65th √ Umum 15/08/2017 Melanoma maligna Wide excisi Melanoma maligna dr.Sukarno intubasi II
153 405887 Ny.Indah Tri W 29th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
154 402020 Ny.Yuli Wulan 26th √ Obgyn G1P0A0+letsu LSCS G1P0A0+letsu dr.Heru B SAB II/VK
155 378455 Ny.Eny Purwanti 36th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB II/VK
156 274912 Ny.Desy Ekawulan 29th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB III/VK
157 409560 Tn.Honny Sasmito 46th √ Umum Appendik perforasi Lap appendictomy Appendik perforasi dr.Sukarno SAB II
158 371646 Ny.Nur Laili 30th √ Obgyn G3P1A1+PPT LSCS G3P1A1+PPT dr.Haris SAB II/VK
159 218481 Ny.Imroatus S 34th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Haris SAB II/VK
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
160 409195 Ny.Lasemi 46th √ Obgyn 16/08/2017 Mioma uteri SOD+wedge resection ov S Mioma uteri dr.Kery SAB III/VK
Release perlengketan bekas Perlengketan adnexa dg
161 409522 Ny.Irma Hernawati 46th √ Obgyn TOA adnexa D+bekas appendik bekas appendik dr.Kery SAB II/VK
162 400534 Ny.Ita Rosita W 35th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
163 408979 Sdr.M.Kharis S 18th √ Umum Fibro lipoma gluteus Excisi Fibro lipoma gluteus dr.Hernowo SAB III
164 370063 Tn.Satuhan 52th √ Ortho Soft tisue tu manus Excisi Soft tisue tu manus dr.Danang masker II
165 409190 Sdr.Iwan A 31th √ Ortho Cl fr ankle Orig plating Cl fr ankle dr.Danang SAB II/TC
166 225486 Ny.Zulmi Lailatul 25th √ Obgyn 17/08/2017 G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK
167 213229 Ny.Sinta Devi 30th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB III/VK
168 409608 Ny.Rini Qurnia 22th √ Obgyn 18/08/2017 G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Kery SAB II/VK
169 404475 Ny.Dewi Ayu K 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
170 250406 Tn.M.Rifai 36th √ Umum Tumor punggung Excisi Tumor punggung dr.Bambang TIVA II/TC
171 409762 Ny.Fitri Kurnia 27th √ Obgyn G2P1A0+letsu LSCS G2P1A0+letsu dr.Kery SAB II/VK
172 406136 Tn.Wasikin 63th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
173 407768 Ny.Noer Novita 23th √ Obgyn G1P0A0+letsu LSCS G1P0A0+letsu dr.Umi SAB II/VK
174 194707 Ny.Miimn Tri S 31th √ Obgyn G5P2A1+BSC LSCS+MOW G5P2A1+BSC dr.Umi SAB I/VK
175 407681 Ny.Windariyati 30th √ Obgyn 19/08/2017 G3P1A1+haemoroid LSCS G3P1A1+haemoroid dr.Kery SAB II/VK
176 408921 An.Wahyu Supras 12th √ Umum Polidactily phalax pedis S Amputasi Polidactily phalax pedis S dr.Sukarno SAB I
177 320257 Ny.Faradiba Surya 28th √ Umum FAM Excisi FAM dr.Hernowo masker I
178 363379 Ny.Lia Andriyani 27th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
179 409292 Ny.Putu Ayunita 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
180 408598 Ny.Rokhima 48th √ Umum 19/08/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB VVIPB
181 407467 Ny.Istirofah 41th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB VVIPA/VK

182 336575 Ny.Dwi Fatmawati 44th √ Obgyn Bartholin cist Excisi Bartholin cist dr.Umi SAB II/VK
183 325048 Ny.Trisna Bella 20th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
184 406840 Ny.Nurul Ubudian 28th √ Obgyn 20/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
185 409916 Ny.Umi Nadhifah 34th √ Obgyn G23P2A0+visus -6 LSCS+MOW G23P2A0+visus -6 dr.Kery SAB II/VK
186 253406 Ny.Sobibatur R 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
187 298002 Ny.Somah 55th √ Bedah mulut Soft tisue maxila Epulsi Soft tisue maxila dr.Henry SAB III
188 409748 Nn.Apriliana Dwi 31th √ Umum FAM Excisi FAM dr.Hernowo TIVA II
189 183338 Ny.Isfaizah 26th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB III/VK
190 391171 Ny.Riana Trisna 35th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Umi SAB VVIPA
191 376493 Ny.Nasikah 53th √ Umum Ca mamae Mastectomy Ca mamae dr.Bambang intubasi II
192 409703 Ny.Kamisah 62th √ Umum Tu sacrum Excisi Tu sacrum dr.Bambang SAB III
193 384804 An.Afif Prihudani 8th √ Ortho Fr tibia S post plating Aff plate Fr tibia S post plating dr.Danang intubasi VVIPA
√ Umum Fimosis Circumsisi Fimosis dr.Hernowo
194 410040 Ny.Annisa Indah 24th √ Obgyn 22/08/2017 G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK
195 228815 Ny.Prihatin 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
196 343485 Ny.Zumaiyah 43th √ Obgyn Mioma uteri SVH+SOS Mioma uteri dr.Kery SAB II/VK
Oovarectomy S+wedge
197 373124 Nn.Ria Rahma 27th √ Obgyn KET resection ov D
Cistoma ovarii pecah dr.Heru B intubasi III/VK
√ Umum Appendictomy dr.Sukarno
198 093716 Ny.Sri Untari 45th √ Umum Hernia lateralis Herniotomy Hernia lateralis dr.Sukarno SAB VIP
199 286243 Ny.Ismaul Ulum 26th √ Umum Abses mamae Excisi Abses mamae dr.Sukarno TIVA II

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
Hemangioma sub Hemangioma sub
200 233153 An.Bima Andika 5th √ Umum 22/07/2017 unguementum digiti I pedis Extraxi kuku unguementum digiti I pedis dr.Hernowo masker I
S S
201 409418 Sdr.Al Hafid 15th √ Umum Tumor colli Incisi+debridement Abses colli dr.Hernowo TIVA II
202 370840 Tn.M.Efendi 46th √ Umum Abses perianal Incisi+debridement Abses perianal dr.Hernowo SAB II
203 215322 Ny.Ika Nuril 30th √ Obgyn G2P1A0+cistoma ov LSCS+SOD G2P1A0+cistoma ov dr.Haris SAB II/VK
204 409626 Ny.Yeni Fatmasari 28th √ Obgyn G2P0A1+post date LSCS G2P0A1+post date dr.Haris SAB II/VK
205 409610 Ny.Dwi Rofiah 35th √ Obgyn G4P2A2+BSC LSCS G4P2A2+BSC dr.Haris SAB III/VK
206 316358 Ny.Dewi Atikah 45th √ Ortho Cl fr radius Orif plating Cl fr radius dr.Danang intubasi PAV
207 390283 Ny.Iftitachul M 29th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Umi SAB I/VK
208 188999 Ny.Dewi Sri 42th √ Obgyn MOW+hipertensi MOW MOW+hipertensi dr.Umi SAB I/VK
209 270707 Ny.Mei Dwi K 25th √ Obgyn 23/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
210 410124 Ny.Suratik 36th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Kery SAB II/VK
211 409738 Ny.Imelda Merana 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
212 110967 Ny.Anik Rahma 33th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Kery SAB I/VK
213 410069 Ny.Binti Istiana 27th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Haris SAB III/VK
214 410064 An.Syaqina K 8th √ Umum Mucocle bibir Exterpasi Mucocle bibir dr.Sukarno intubasi II/TC
215 378363 Ny.Lasminah 58th √ Umum Ulcus pedis D Exterpasi Ulcus pedis D dr.Sukarno SAB II/TC
216 311866 Ny.Sulis Wanti 44th √ Umum Haemoroid G IV Haemoroidectomy Haemoroid G IV dr.Sukarno SAB III/TC
217 406425 Ny.Hartina 51th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB I/VK

218 239499 Ny.Yulia Febria 27th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
219 312042 Ny.Chulliatus 47th √ Umum Ca mamae Mastectomy Ca mamae dr.Hernowo intubasi II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
Bedah
220 409112 An.Adinda K 5th √ mulut 23/08/2017 Mucocle bibir Excisi Mucocle bibir dr.Henry TIVA II
221 409952 Ny.Retnoningsih 54th √ Umum Hemangioma infra orbita Excisi Hemangioma infra orbita dr.Hernowo masker I
222 387883 Tn.Ronny F 49th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
223 335735 Tn.Temu Susanto 53th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III
224 330101 Tn.Okkik Tri 35th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB I
225 409284 Ny.Puji Astutik 39th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo intubasi II
226 397569 Ny.Anita Dwi Z 35th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Umi SAB III/VK
227 407676 Ny.Dwi Kartika S 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
228 410160 Ny.Khuridatur 25th √ Obgyn G1P0A0+oligohidramnion LSCS+Insersi IUD G1P0A0+oligohidramnion dr.Umi SAB III/VK
229 350092 Ny.Nanik Susilo 36th √ Obgyn G3P2A0+BSC LSCS+Insersi IUD G3P2A0+BSC dr.Umi SAB I/VK
230 212941 Ny.Diah Kartika 31th √ Obgyn 24/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
231 397522 Ny.Indah Budi L 49th √ Obgyn Mioma uteri SVH+SOS Mioma uteri+cistoma ovarii dr.Kery SAB III/VK
232 180603 Ny.Elis Nike 39th √ Obgyn G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB III/VK
233 404948 Ny.Nindy Widya 20th √ Obgyn Cistoma ovarii Ewedge resection ov S+D Cistoma ov coklat duplek dr.Heru B SAB I/VK
234 404648 Ny.Eti Mulyani 36th √ Umum CKD AV shunt CKD dr.Hernowo LA RJ
235 222754 An.Assalia Fresya 13th √ Umum Ganglion manus D Excisi Ganglion manus D dr.Hernowo masker II
236 367429 Ny.Lulus Setya 39th √ Obgyn TOA SOD Cistoma ovarii D dr.Kery SAB II/VK
237 410170 Ny.Sumbang Sari 55th √ Umum Abses cruris Incisi+debridement Abses cruris dr.Bambang SAB III/TC
238 410079 Ny.Yunike Wulan 30th √ Umum FAM Excisi FAM dr.Bambang TIVA II/TC
239 409222 Ny.Siti Halimah 32th √ Obgyn Cistoma ovarii duplex Cistectomy S+D Cistoma ovarii duplex dr.Kery SAB III/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
240 368187 Tn.Ahmad 73th √ Umum 24/08/2017 Tumor elbo S Excisi Tumor elbo S dr.Bambang masker II/TC
241 410258 Ny.Emil Puji L 34th √ Obgyn G3P2A0+PEB LSCS+MOW G3P2A0+PEB dr.Kery SAB I/VK
242 260976 Ny.Tri Indah O 21th √ Umum 25/08/2017 FAM duplex Exterpasi FAM duplex dr.Sukarno masker II/TC
243 408928 Ny.Yuliati 38th √ Obgyn G4P3A0+PP LSCS G4P3A0+PP dr.Kery SAB III/VK
244 398246 Ny.Dwi Ayu K 27th √ Obgyn G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Kery SAB I/VK
245 372876 Nn.Apri Susanti 24th √ Umum FAM Exterpasi FAM dr.Sukarno masker II/TC
246 394227 Ny.Eka Fatmawati 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
247 191135 Ny.Pujiati 32th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB III/VK
248 369584 Ny.Titin S 33th √ Obgyn G5P1A4+letsu LSCS G5P1A4+letsu dr.Kery SAB II/VK
249 404330 Tn.M.Thoriq H 47th √ Umum Tumor occipital Excisi Tumor occipital dr.Bambang masker I/TC
250 410181 Sdr.Helmi Maula 21th √ Umum Tumor temporal Excisi Tumor temporal dr.Bambang TIVA III/TC
251 410196 Ny.Bekti sulistyowati 44th √ Umum Haemmoroid gr III hAemmoroidectomy Haemmoroid gr III dr.Bambang SAB III/TC
252 319789 Ny.Paryanti 41th √ Umum Ca.Mamae Mastectomy Ca.Mamae dr.Bambang Intubasi II/TC
253 301101 An.Tedy Maulana 8th √ Umum cl.fr.Humerus orif plating cl.fr.Humerus dr.Hari C Intubasi III
Post curet IUFD+tdpt mioma
254 407423 Ny.Purwaningsih 34th obgyn Post curetage curetage uteri dr.Kery SAB II/VK
255 410397 Ny.Yuliati 31th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB III/VK
256 410384 Ny.Ajeng B 23th √ obgyn Gi P0-0 + riw.TBC LSCS Gi P0-0 + riw.TBC dr.Kery SAB I/VK
257 165742 Ny.Rodiya Ulfa 37th √ obgyn G2 P1-1 + letsu LSCS G2 P1-1 + letsu dr.Kery SAB III/VK
258 410057 Ny.Umi Habibah 25th √ obgyn GiP0-0 + Letsu LSCS GiP0-0 + Letsu dr.Kery SAB II/VK
259 410482 Ny.Idcholus 24th √ obgyn G1P0-0 + Partus kasep LSCS G1P0-0 + Partus kasep dr.Kery SAB III/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI √
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
260 410337 Tn.Sobirin 46th √ Umum 27/08/2017 Abses mamae Incisi+debridement Abses mamae dr.Hernowo Masker III
261 181440 Ny.Niswatul M 42th √ Umum 28/08/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB I
262 401305 Tn.Cipto Hartono 77th √ Umum Nekrosis jari pedis Amputasi Nekrosis jari pedis dr.Sukarno SAB III
263 204429 Ny.Anita Rahma 32th √ Umum Tumor kepala Exterpasi Tumor kepala dr.Sukarno intubasi II
264 346227 Ny.Khusnul K 54th √ Umum Multiple lipoma Excisi Multiple lipoma dr.Hernowo TIVA II
265 410282 Ny.Lilik Umiek S 54th √ Umum Ganglion manus Excisi Ganglion manus dr.Hernowo Masker I
266 410033 Ny.Fidha Nur A 46th √ Umum FAM Excisi FAM dr.Hernowo TIVA III
267 407544 Ny.Ninik Mahroja 31th √ Umum FAM Excisi FAM dr.Hernowo Masker II
268 258519 Tn.Nur Jayadi 40th √ Umum Tumor punggung Excisi Tumor punggung dr.Hernowo TIVA II
269 410076 Ny.Zaenab Nur F 49th √ Umum Nekrosis digiti I pedis Amputasi+debridement Nekrosis digiti I pedis dr.Hernowo SAB II
270 408346 Tn.Sumalyo H 25tn √ Umum CKD AV shunt CKD dr.Hernowo LA RJ
271 396514 Tn.Jasin Wahono 47th √ Umum Multiple lipoma Multiple excisi Multiple lipoma dr.Bambang TIVA II
272 409478 Tn.Doni Ari A 46th √ Umum Struma Total lobectomy Struma dr.Bambang intubasi VVIPA

273 410570 Ny.Fitriyah 30th √ Obgyn G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB III/VK
274 407080 Ny.Fatimah 31th √ Obgyn G2P1A0+APB LSCS G2P1A0+APB dr.Kery SAB I/VK
275 410584 Ny.Yesy Anatia S 24th √ Obgyn G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Kery SAB II/VK
276 247722 Ny.Khotimatus S 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
277 410608 Tn.Eko Wahyu 25th √ Ortho Opfr tibia 1/3 tengah S Orig plating+debridement Opfr tibia 1/3 tengah S dr.Danang SAB II
278 407134 An.Annasya 1th √ Umum Febris Vena sectie Febris dr.Hernowo LA III
279 370415 An.M.Ferrel Agung 1th √ Umum 29/08/2017 HIL Herniotomy HIL dr.Sukarno Masker III/TC

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
280 275842 Ny.Susiati 33th √ Umum 28/08/2017 Tumor mamae S Excisi Tumor mamae S dr.Sukarno TIVA II/TC
281 410607 Ny.Erlangga Adi 14th √ Umum Tumor telinga Exterpasi Tumor telinga dr.Sukarno TIVA II/TC
282 410210 Nn.Krisna Mega 28th √ Umum Appendik akut Appendictomy Appendik akut dr.Sukarno SAB 1/TC
283 276923 Ny.Sulistiani 38th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Kery SAB II/VK
284 410634 Ny.Siska Susilo 51th √ Obgyn Mioma uteri SVH+cistectomy S Mioma uteri dr.Kery SAB I/VK
285 332582 Ny.Anis Naimah 28th √ Obgyn Mioma uteri SVH+SOD Mioma uteri dr.Kery SAB II/VK
286 409739 Ny.Endriyana S 33th √ Obgyn G2P0A1+PP LSCS G2P0A1+PP dr.Umi SAB II/VK
287 407209 Ny.Ema Siti M 28th √ Umum CKD AV shunt CKD dr.Hernowo LA RJ
288 27026 Ny.Fitri Pancar S 26th √ Obgyn G1P0A0+KPP LSCS G1P0A0+KPP dr.Heru B SAB III/VK
289 394595 Ny.Istianah 23th √ Obgyn G1P0A0+kepala floating LSCS G1P0A0+kepala floating dr.Kery SAB II/VK
290 237747 Tn.Wibowo Eko 48th √ Umum Nekrosis digiti III pedis Amputasi+debridement Nekrosis digiti III pedis dr.Hernowo SAB II
Fr cruris post Fr cruris post
291 408969 Tn.Hakim Safroni 49th √ Ortho plating+osteomilitis Aff plate plating+osteomilitis dr.Danang SAB I
292 409114 Ny.Sukma Rizki 27th √ Obgyn G2P1A0+PEB+BSC LSCS G2P1A0+PEB+BSC dr.Umi SAB II/VK
293 410691 Ny.Samini 63th √ Ortho Op fr phalax prox digiti III Orif pining+debridement Op fr phalax prox digiti III dr.Danang intubasi II
Rinosinusitislabio dg konka Rinosinusitislabio dg konka
294 007158 Ny.Ismailah 34th √ THT hypertropi
Antrostomi intranasal 22-2
hypertropi dr.Nur Sofi intubasi II
295 409962 Sdr.Iwan Gunawan 23th √ THT Pseudo koma auricle Incisi Pseudo koma auricle dr.Nur Sofi TIVA I
296 410615 Tn.Bram Bratama 34th √ Umum 30/08/2017 Abses leher+DM Incisi+debridement Abses leher+DM dr.Sukarno TIVA II
297 169968 Ny.Ayu Sito R 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
298 409096 Ny.Nining Wahyu 33th √ Obgyn G3P1A0+BSC LSCS G3P1A0+BSC dr.Kery SAB II/VK
299 410420 Nikmatul Laili 23th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
300 410163 Tn.M.Yusro Alifan 37th √ Umum 30/08/2017 Multiple lipoma Excisi Excisi dr.Hernowo Masker I
301 410144 Ny.Selly Buniati 43th √ Umum FAM Excisi Excisi dr.Hernowo Masker I
302 409303 Ny.Na'ama 65th √ Umum Ganglion poplitea Excisi Excisi dr.Hernowo SAB II
303 222398 Tn.Edi Sugiharto 60th √ Umum Abses gluteus Incisi+debridement Incisi+debridement dr.Hernowo SAB VVIPB

304 410292 Nn.Binti Nur C 22th √ Umum FAM Excisi Excisi dr.Bambang TIVA III
305 410356 Tn.Jazuli 28th √ Umum Struma Libectomy Libectomy dr.Bambang intubasi II
G1P0A0+PEB+ketuban
306 410728 Ny.Siti Mufaroka 23th √ Obgyn G1P0A0+PEB LSCS+insesrsi IUD mekoneal dr.Umi SAB III/VK
307 405105 Ny.Dewi Astiya 34th √ Obgyn G3P2A0+BSC LSCS LSCS dr.Umi SAB II/VK
308 197438 Ny.Lisdiana 42th √ Obgyn G4P3A0+PPM LSCS+MOW LSCS+MOW dr.Umi SAB I/VK
309 409601 Tn.Septiyan Dwi 27th √ Umum Haemoroid Haemoroidectomy Haemoroidectomy dr.Bambang SAB II
310 328705 Ny.Sugianik 50th √ Obgyn Mioma uteri SVH SVH dr.Kery SAB II/VK
311 410409 Ny.Yustiani 49th √ Obgyn Mioma uteri+cistoma ov SVH+SOD SVH+SOD dr.Kery SAB I/VK
312 288537 Tn.Amien Agus 63th √ Umum CKD AV Shunt AV Shunt dr.Hernowo LA RJ
√ Cruss injuri phalax distal
313 389670 Tn.Agus Dwi S 30th Obgyn digiti IV manus D
Amputasi+debridement dr.Danang masker II/TC
314 302731 Ny.Sri Nur Aini 34th √ Obgyn 31/08/2017 Mioma uteri+cistoma ov Miomectomy+SOS Miomectomy+SOS dr.Kery SAB III/VK
315 314027 Tn.Rifai 65th √ Umum Tumor punggung Excisi Excisi dr.Hernowo TIVA II
316 410830 Tn.Mujiono 58th √ Umum HIL Herniotomy Herniotomy dr.Sukarno SAB II
317 312494 Ny.Nuril Mufidah 26th √ Umum Cholelitiasis Cholesistectomy Cholesistectomy dr.Bambang SAB II
318 377819 Ny.Fivelina S 27th √ Obgyn G2P1A0+BSC LSCS LSCS dr.Umi SAB II/VK
319 410074 Ny.Rohmatin N 27th √ Obgyn G2P1A0+oligohidramnion LSCS LSCS dr.Umi SAB II/VK

320 320532 Ny.Sri Rahayu N 47th √ Obgyn 31/08/2017 Mioma uteri SVH+SOS Mioma uteri dr.Umi SAB I/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN AGUSTUS TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
L P KH B S K HESI
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
2/V √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ ALLIAnz
4/I √ √ √

1/III √ √ √

2/III √ √ √
2/I √ √ √
1/I √ √ √

2/II √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √
1/III √ √ √

1/IV √ √ √

2/III √ √ √

1/III √ √ √

2/IV √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/IV √ √ √

4/I √ √ √

3/I √ √ √

4/I √ √ √

4/II √ √ √

2/I √ √ √
3/II √ √ √

1/I √ √ √

2/III √ √ √

1/II √ √ √

1/V √ √ √

3/III √ √ √

2/III √ √ √

1/III √ √ √

1/IV √ √ √

4/II √ √ √

3/IV √ √ √

2/IV √ √ √

3/I √ √ √

1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ ASTRA
3/III √ √ √

2/III √ √ √

2/IV √ √ √

1/III √ √ √

2/IV √ √ √

4/II √ √ √

2/II √ √ √

1/II √ √ √

3/III √ √ √

3/I √ √ √

2/I √ √ √

4/I √ √ √

3/II √ √ √
2/II √ √ √
3/III √ √ √
3/I √ √ √
2/I √ √ √

2/II √ √ √
1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

2/I √ √ JCI
2/I √ √ √

4/II √ √ √

4/I √ √ √

1/I √ √ JAI
1/II √ √ √

3/I √ √ √

3/II √ √ √

2/III √ √ √

2/IV √ √ √
1/IV √ √ √

2/IV √ √ √

1/I √ √ √

3/III √ √ √

3/IV √ √ √

1/IV √ √ √

2/IV √ √ √

4/II √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ CAR
2/II √ √ √

3/I √ √ √
2/II √ √ √

1/I √ √ √

4/I √ √ √

2/III √ √ √

1/II √ √ lippo general


1/III √ √ COMFEED
2/IV √ √ √

3/IV √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

1/I √ √ √

2/III √ √ √

3/III √ √ √

3/IV √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

3/V √ √ √

1/III √ √ √

4/I √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ RBH
1/II √ √ √

3/II √ √ √

2/III √ √ √

3/I √ √ √

3/II √ √ √

3/I √ √ √

4/I √ √ √
1/II √ √ √

2/II √ √ √

3/II √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/III √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √
2/II √ √ √

1/II √ √ √

3/III √ √ √

4/I √ √ √

2/I √ √ √

1/I √ √ √

2/I √ √ RBH
1/II √ √ angkasa pura
3/I √ √ √

4/I √ √ √

4/II √ √ COMFFED
3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/III √ √ √

2/IV √ √ √

3/III √ √ √

1/III √ √ √

1/II √ √ √

3/IV √ √ √

4/III √ √ √

2/IV √ √ √

2/V √ √ √

4/II √ √ √

2/IV √ √ √

3/V √ √ √

1/I √ √ √

3/II √ √ √

2/II √ √ √

2/I √ √ √

2/III √ √ √

1/II √ √ √

2/III √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/IV √ √ √

1/III √ √ √

3/III √ √ √

1/III √ √ √

2/IV √ √ √

4/I √ √ √

2/I √ √ √

3/I √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/II √ √ √
2/II √ √ √

3/II √ √ √

2/III √ √ √

3/I √ √ √

4/I √ √ √

1/I √ √ √

2/II √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √

2/III √ √ √

1/II √ √ √

3/III √ √ √
3/I √ √ √

3/II √ √ √

2/I √ √ √

4/I √ √ √

1/I √ √ √

3/III √ √ √

3/II √ √ √

2/III √ √ √

1/II √ √ √

4/I √ √ √
√ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ √

1/I √ √ pertamina
3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi
Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √

3/II √ √ √

3/IV √ √ √

2/III √ √ √

1/IV √ √ √

1/III √ √ √

4/II √ √ √

2/IV √ √ √

2/V √ √ √

2/I √ √ √

3/I √ √ √

2/II √ √ √

3/II √ √ √

4/I √ √ √
1/I √ √ √

1/II √ √ √

1/III √ √ √

2/III √ √ √

3/III √ √ √
√ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/III √ √ √

2/IV √ √ √

3/IV √ √ √

1/I √ √ √

1/IV √ √ Adira
2/IV √ √ √

3/IV √ √ √
4/III √ √ √

2/V √ √ √

3/V √ √ √

2/IV √ √ √

2/II √ √ √

1/I √ √ √

3/I √ √ √

4/I √ √ √

4/II √ √ √

1/II √ √ √

1/III √ √ √

2/III √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

4/III √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ √

2/I √ √ √

3/III √ √ JAI
3/IV √ √ √

1/III √ √ √

2/III √ √ √

1/II √ √ √

2/III √ √ √

4/I √ √ HanwhaLife
4/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/II √ √ √
2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

2/I √ √ Comfeed
1/I √ √ √

2/II √ √ √

1/III √ √ √

4/III √ √ √

1/II √ √ √

4/II √ √ √

1/III √ √ √

1/IV √ √ √

4/III √ √ √
1/II √ √ √

2/II √ √ AIA
3/III √ √ √

3/I √ √ √

3/IV √ √ √

3/V √ √ √

4/III √ √ √

1/IV √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ √

1/I √ √ √

1/II √ √ √
3/I √ √ √

4/I √ √ √

3/II √ √ √

2/II √ √ √

4/I √ √ √

3/IV √ √ √

3/III √ √ √

2/IV √ √ √

1/III √ √ √

3/IV √ √ √

4/III √ √ √

1/III √ √ Comfeed
1/IV √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
2/I √ √ √

4/I √ √ √

1/II √ √ √

1/III √ √ Manulife
2/III √ √ JAI
2/II √ √ √

3/III √ √ √

3/IV √ √ √

3/V √ √ √

1/III √ √ √

4/II √ √ √

2/IV √ √ √

4/I √ √ √

4/II √ √ √
3/I √ √ √

3/II √ √ √

1/I √ √ √

2/I √ √ √

3/III √ √ √

2/II √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 358680 Ny.Siti Lindia 29th √ Obgyn 01/08/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
2 407556 Ny.Rahayu W 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK

3 406278 Ny.Iis Suryani 31th √ Obgyn G5P2A2+PPM LSCS G5P2A2+PPM dr.Umi SAB II/VK
4 288821 Ny.Mujiati 29th √ Umum FAM Exterpasi FAM dr.Sukarno masker II
5 341275 Ny.Susanti A 33th √ Obgyn G1P0A0+haemoroid LSCS G1P0A0+haemoroid dr.Umi SAB II/VK
6 302748 Ny.Fidyanti W 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
7 342313 Ny.Indah Nur M 42th √ THT Polip konkah Antrostomy Rinosinusitis dr.Noer S masker VIP
8 411016 Ny.Erlin Virgasari 29th √ Obgyn 03/09/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
9 169849 Tn.A.Rozi 82th √ Mata 04/09/2017 Os ruptur suporbita D Os esvervesi Os ruptur suporbita D dr.Tauhid masker III
10 410294 Ny.Soelistiastuti 43th √ Umum Ganglion carpi D Exterpasi Ganglion carpi D dr.Sukarno masker I
11 352463 Ny.Yuni Permata 26th √ Obgyn G1P0A0+astma LSCS G1P0A0+astma dr.Heru B SAB I/VK

12 409613 An.Rafadhan E 1th √ Umum Tumor humerus Excisi Tumor humerus dr.Bambang masker II/TC
13 410747 An.Arraikhan 7th √ Umum Tumor nasal Excisi Tumor nasal dr.Bambang TIVA I/TC
14 410757 An.Taslimatus S 7th √ Umum Tumor temporalis Excisi Tumor temporalis dr.Bambang masker III
15 206176 Tn.Suyono 64th √ Umum Ganglion manus S Excisi Ganglion manus S dr.Hernowo masker II
Peritonitis susp appenidic
16 410979 Ny.Luluk Erna S 49th √ Umum perforasi
Lap appendictomy Appendicitis perforasi dr.Hernowo SAB III
17 410770 Tn.M.Zainul A 29th √ Umum Tumor dinding dada Excisi Tumor dinding dada dr.Hernowo TIVA II/TC
18 409969 Ny.Fatmala M 26th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB III/VK
19 212692 Ny.Chikmatun N 27th √ Obgyn 05/09/2017 G2P1A0+kepala floating LSCS G2P1A0+kepala floating dr.Kery SAB III/VK

20 370500 Nn.Anis Dwi J 23th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB III/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 297911 Ny.Nunik Nurul 25th √ Obgyn 05/09/2017 G1POA0+PP LSCS G1POA0+PP dr.Kery SAB II/VK
22 410679 Ny.Hj.Suhartini 45th √ Obgyn Mioma uteri SVH+SOD Mioma uteri dr.Kery SAB III/VK
SVH digantung dg ke2
23 410319 Ny.Siti 51th √ Obgyn Perolap uteri rotundum Perolap uteri dr.Kery SAB II/VK
24 411101 Tn.Sutiyo 54th √ Umum HIL Heniotomy HIL dr.Sukarno SAB III
25 411082 Tn.Rizal Satria 32th √ Umum Tumor punggung Exterpasi Tumor punggung dr.Sukarno TIVA II
26 411087 Tn.Siswoyo 44th √ Umum Ganglion poplitea Exterpasi Ganglion poplitea dr.Sukarno SAB II
SVH+BSO+omentektomi
27 411162 Ny.Mistariah 55th √ Obgyn Cistoma ovarii+polip cervix
partial+exterpasi polip
Cistoma ovarii+polip cervix dr.Haris SAB II/VK
28 377460 Ny.Marni Suniar 51th √ Umum Ulcus pedis+abces Incisi+debridement Ulcus pedis+abces dr.Hernowo SAB I
29 409929 Ny.Linda Febrina 35th √ Umum FAM Excisi FAM dr.Hernowo Masker II
30 155655 Ny.Darmawati 42th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
G3P2A0+IUFD+cistoma
31 411194 Ny.Nofi Sri H 42th √ Obgyn G3P2A0+IUFD LSCS+SOD ovarii dr.Umi SAB II/VK
32 411216 Nn.Riza Palifi 29th √ Umum 06/09/2017 Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB PAV
33 411086 Tn.Kateno 45th √ Umum HIL Herniotomy HIL dr.Sukarno SAB I
34 411178 Nn.Putri Siam 15th √ Umum FAM Excisi FAM dr.Sukarno Masker III
35 372039 Ny.Catur Roosi 31th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK
36 407690 Ny.Yuvita Putri 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
37 372333 Ny.Tri Midya 28th √ Obgyn G2P0A1+post KET LSCS G2P0A1+post KET dr.Kery SAB III/VK

38 409607 Ny.Dwi Maharani 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
39 310126 Ny.Ayu Machroni 29th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Haris SAB II/VK
40 001422 Ny.Resa Waheda 26th √ Obgyn G1P0A0+riw astma LSCS G1P0A0+riw astma dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 276036 Tn.Maksum 50th √ Umum 06/09/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
42 406683 Ny.Ruly Arum 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB III/VK
43 398189 Nn.Ika Ayu 24th √ Umum FAM Excisi FAM dr.Hernowo Maker III
44 411099 An.Indra Karisma 11th √ Umum Ganglion manus Excisi Ganglion manus dr.Hernowo mas II
45 411090 Tn..Andi Yanuar 44th √ Ortho Cl fr clavicula Orif plating Cl fr clavicula dr.Danang Intubasi II/TC
46 409269 Ny.Zulaikah 51th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo Intubasi III
47 411134 Tn.Suratmo 58th √ Umum Apendik perforasi Lap appendictomy Apendik perforasi dr.Hernowo SAB I
48 409092 Ny.Sumariyah 60th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB III
49 410056 Ny.Rizka Nurul 26th √ Obgyn 07/09/2017 G1P0A0+letsu LSCS G1P0A0+letsu dr.Umi SAB I/VK
50 410794 Ny.Murti Rahayu 28th √ Obgyn G3P1A1+CPD LSCS G3P1A1+CPD dr.Kery SAB II/VK
51 241207 Ny.Esti Choiriyah 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
52 259557 Ny.Diah Priyasih 33th √ Obgyn G5P3A1+BSC LSCS+MOW G5P3A1+BSC dr.Haris SAB I/VK
53 410573 Ny.Sayuti 38th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
54 374277 Ny.Suci Kusuma 46th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB VIP
55 406114 An.Maulida 14th √ Umum Tumor bibir bawah Excisi Tumor bibir bawah dr.Bambang TIVA I/TC
56 354154 Nn.Diah Rahma 17th √ Umum Appendic perforasi Lap appendictomy Appendic perforasi dr.Bambang SAB II/TC
57 411250 Ny.Sri Wahyuni 34th √ Umum Ganglion manus Excisi Ganglion manus dr.Bambang TIVA II/TC
58 407209 Ny.Ema Siti M 28th √ Anestesi CKD st IV Aff CVC CKD st IV dr.Ary F LA II
59 382098 Nn.Gabriel A 15th √ Umum FAM Excisi FAM dr.Bambang TIVA II/TC
60 411046 An.Jenna Ziyan I 5th √ Umum Abses axilla Incisi+debridement Abses axilla dr.Hernowo TIVA VVIPA
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 404620 Ny.Giriasih Indah 39th √ Obgyn 07/09/2017 G2P1A0+PPT LSCS G2P1A0+PPT dr.Umi SAB II/VK
62 295239 Ny.Diah Ike S 40th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB II/VK
63 336805 Ny.Lalul fatmawati 25th √ Obgyn 08/09/2017 G2P1A0+BSC Lscs G2P1A0+BSC dr.Haris SAB I/VK
64 275287 An.Endra dalu taja 5th √ Ortho Cl.Fr.Cruris Reposisi + psg Gibs Cl.Fr.Cruris dr.Danang TIVA II/TC

65 411164 Ny.Nurjani H 67th √ Umum Cholelitiasiss Cholecystectomy Cholelitiasiss dr.Hernowo SAB VVIP A

66 330458 Ny.Atianah 46th √ Ortho Cl.Fr.Neck MC V Orif Pining Cl.Fr.Neck MC V dr.Danang Masker VVIP B
67 366875 Ny.Henny purwanti 33th √ Obgyn G2P1A1+ oligohidramnion LSCS G2P1A1+ oligohidramnion dr.Umi SAB II/VK
68 393529 Ny.Ayu Melasari 26th √ Obgyn G2P1A0+ BSC LSCS G2P1A0+ BSC dr.Umi SAB I/VK
69 411452 Ny.Kristian angga 25th √ Obgyn G2 P1A0+ oligohidramnion LSCS G2 P1A0+ oligohidramnion dr.Umi SAB II/VK
70 411260 Ny.Novi Purwanti 39th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Bambang SAB III/TC
71 410754 Ny.Ayu Wandiyah 27th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
72 411520 Ny.Ma'rufah 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
73 402854 Ny.Novia Hartika 29th √ Obgyn G2P1A0+BSC LSCS+insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
74 393432 Ny.Evi Lutfiah 31th √ Obgyn G4P3A0+PPM LSCS+MOW G4P3A0+PPM dr.Umi SAB III/VK
75 406570 Ny.Rusdianah 34th √ Obgyn 10/09/2017 G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB II/VK
76 284532 Ny.Aristia Nurma 31th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Umi SAB II/VK
77 401885 Ny.Siti Romlah 62th √ Umum 11/09/2017 Ganglion carpi Excisi Ganglion carpi dr.Sukarno Masker I/TC
78 411366 Ny.Dewi Wijaya 31th √ Umum Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno TIVA III
79 411359 Ny.RR.Sri Suryani 61th √ Umum Tumor punggung Exterpasi Tumor punggung dr.Sukarno TIVA I/TC
80 407209 Ny.Ema Sri M 28th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA RJ
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B √ K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 286603 Ny.Tutik Wolujeng 54th √ Umum 11/09/2017 CKD AV Shunt CKD dr.Hernowo LA RJ
82 371342 Tn.Ronny H 68th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB I
83 411443 Nn.Anisa Nur C 15th √ Umum Ganglion pedis Excisi Ganglion pedis dr.Bambang SAB II/TC
84 344324 An.Wildhan Tri 4th √ Ortho Tingger fingger digiti III Release tendon Tingger fingger digiti III dr.Danang Intubasi II/TC
85 407678 Ny.Santri Sulowati 46th √ Umum Appendicitis Appendictomy Appendicitis dr.Hernowo SAB II
86 306290 Tn.Sri Hadi 49th √ Ortho Op fr phalax distal digiti I Orif pining+debridement Op fr phalax distal digiti I dr.Danang SAB PAV
87 326453 Ny.Luluk R 27th √ Obgyn G1P0A0+Oligohidramninon LSCS G1P0A0+Oligohidramninon dr.Umi SAB III/VK
88 406414 Ny.Timtim Dili 41th √ Obgyn Cistoma ovarii Oovarectomy partial D Cistoma ovarii dr.Umi SAB II/VK
89 406837 Ny.Roudhotul J 29th √ Obgyn G1P0A0+Fetal distres LSCS G1P0A0+Fetal distres dr.Haris SAB III/VK
90 328945 Ny.Rike Resti N 21th √ Obgyn 12/09/2017 G1P0A+letsu LSCS G1P0A+letsu dr.Kery SAB VVIPB

91 411078 Ny.Nurul Q 21th √ Obgyn GIP0A0+PEB LSCS GIP0A0+PEB dr.Kery SAB II/VK
92 408122 Ny.Siti Muawanah 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
93 408119 Ny.Isnawati 33th √ Obgyn G3P2A0+PROM LSCS+Insersi IUD G3P2A0+PROM dr.Umi SAB I/VK
94 411700 Ny.Nudia Metalina 30th √ Obgyn G3P2A0+letsu LSCS+MOW G3P2A0+letsu dr.Kery SAB II/VK
95 411112 Ny.Rita Ratna D 32th √ Obgyn G2P1A0+Letsu LSCS+Insersi IUD G2P1A0+Letsu dr.Umi SAB I/VK
Release
Cistoma ovarii yg menempel
96 407695 Ny.Nafiatul M 33th √ Obgyn Mioma uteri perlengketan+wedgeresecti
pd dinding uterus dr.Kery SAB II/VK
on ov D
97 291068 Ny.Siti Lestari 31th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
98 406304 Ny.Sulismiati 57th √ Bdh mulut Tumor maxila Excisi Tumor maxila dr.Henry Intubasi I
99 136783 Tn.Slamet 60th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA VVIPB

100 407420 Ny.Hayu Tafriziya 26th √ Obgyn G2P1A0+Letsu LSCS+Insersi IUD G2P1A0+Letsu dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
101 409298 Ny.Anita Susilo 33th √ Obgyn 13/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
102 316035 Ny.Wimpi Permata 34th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB I/VK
103 411792 Ny.Novi Ikanita 38th √ Obgyn G2P1A0+BSC LSCS+MOW G2P1A0+BSC dr.Haris SAB II/VK
104 262024 Ny.Siska Amalia 23th √ Umum Hernia femoralis Herniotomy Hernia femoralis dr.Sukarno SAB III/TC
105 411722 Sdr.Agiel P 17th √ Umum Tumor kepala Exterpasi Tumor kepala dr.Sukarno TIVA II/TC
106 411742 Tn.M.Imron 34th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II/TC
107 395444 Ny.Sulistyani 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
108 411721 Ny.Andini Rizky 28th √ Obgyn G1P0A0+post date LSCS G1P0A0+post date dr.Umi SAB II/VK
109 409906 Ny.Indah Wayuni 44th √ Obgyn Cistoma ovarii SOS Cistoma ovarii dr.Umi SAB II/VK
110 266510 Ny.Zainatul F 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
111 411416 Ny.Ratna Kusuma 35th √ Obgyn 14/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB I/VK
112 401248 Ny.Wulandari 33th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK
113 411886 Ny.Listyo Ningsih 34th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB II/VK
114 392979 Ny.Nunung Ratna 43th √ Obgyn G6P4A1+letsu LSCS+MOW G6P4A1+letsu dr.Kery SAB I/VK
115 238000 Ny.Mike Lia P 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
116 386141 Ny.Trie Ayuningtias 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK

117 300600 Ny.Rini Febrian 32th √ Obgyn G1P0A0+Hbs Ag+ LSCS G1P0A0+Hbs Ag+ dr.Heru B SAB III/VK
118 372266 Ny.Nuning Tyas 26th √ Obgyn G3P2A0+PEB LSCS G3P2A0+PEB dr.Haris SAB III/VK
119 246370 Ny.Hariyanti 48th √ Umum Tumor antebrachii Excisi Tumor antebrachii dr.Hernowo TIVA III
120 000199 Ny.D.Manurah 44th √ Umum Tumor femur Excisi Tumor femur dr.Hernowo SAB II

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP G2P1A0+BSC OPERATOR INAP
L P HESI

121 409459 Ny.Fatimatuz Z 35th √ Obgyn 14/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

122 394278 Ny.Suci Sukma 29th √ Obgyn G2P1A0+BSC LSCS G3P2A0+BSC dr.Umi SAB II/VK

123 186916 Ny.Rizki Dwi R 27th √ Obgyn G3P2A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

124 353016 Ny.Anasti Sagita 26th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK

125 253976 Ny.Kusniati 29th √ Obgyn Cista bartilin Cistectomy Cista bartilin dr.Umi SAB II/VK
√ Cl fr phalax proximal digiti III Cl fr phalax proximal digiti III
126 411401 Tn.Sueb 60th Ortho manus D Orif pining manus D dr.Danang Masker II

127 411940 Sdr.Isya' Ramdoni 14th √ Umum Appendicitis perforasi Lap appendictomy Appendicitis perforasi dr.Sukarno SAB II
128 411063 Ny.Imaniar F 32th √ Obgyn 15/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

129 411146 Ny.Mira Monika 28th √ Obgyn G2P1A0+high miopi LSCS G2P1A0+high miopi dr.Umi SAB II/VK

130 411392 Ny.Lailatul 21th √ Umum FAM Exterpasi FAM dr.Sukarno TIVA I

131 315072 Ny.Purwati 43th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II

132 411931 Tn.Suhartono 58th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II

133 289760 Nn.Nanda Dessy 18th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Bambang TIVA I

134 410550 Ny.Munawaroh 63th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo Intubasi I

135 240491 Ny.AgustinZahra 33th √ Obgyn G2P1A0+BSC+APB LSCS G2P1A0+BSC+APB dr.Kery SAB II/VK

136 335240 Ny.Intan Nilasari 29th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Kery SAB I/VK

137 359859 Ny.Febrianti Al H 33th √ Obgyn G3P2A0+BSC LSCS+Insersi IUD G3P2A0+BSC dr.Umi SAB II/VK

138 411934 Ny.Siti Munawaroh 26th √ Obgyn G1P0A0+oligohidramnion LSCS G1P0A0+oligohidramnion dr.Umi SAB III/VK

139 407664 Ny.Yuyun Anggraeni 26th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB I/VK

140 406530 Tn.Noer Cholis 57th √ Anestesi CKD Aff CVC CKD dr.Ary F LA RJ

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
141 378557 Ny.Sulin 54th √ Umum 16/09/2017 Nekrptik digiti pedis +DM Amputasi+rekontruksi Nekrptik digiti pedis +DM dr.Sukarno SAB I
142 217526 Ny.Jawarul Husni 51th √ Umum Gangren pedis+DM Debridement Gangren pedis+DM dr.Sukarno SAB VVIPA

143 002941 Ny.Umaiyah 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
144 410656 Tn.Heri Santoso 43th √ Umum CKD AV shunt CKD dr.Hernowo LA RJ
145 411675 Ny.Popy Triani 28th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Umi SAB I/VK
146 219690 Ny.Fitrah Iswahyuni 32th √ Obgyn G2P1A0+PPT LSCS G2P1A0+PPT dr.Umi SAB I/VK
147 408294 Ny.Indah Rusdia 26th √ Obgyn 17/09/2017 G1P0A0+gemelli LSCS G1P0A0+gemelli dr.Umi SAB II/VK
148 412182 Ny.Winu Yulia 33th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB III/VK
149 336452 Ny.Eni Puji L 32th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
150 406465 Ny.Mariana Ulfa 40th √ Obgyn G2P1A0+HbSAg + LSCS+MOW G2P1A0+HbSAg + dr.Kery SAB II/VK
151 304893 Ny.Juwariyanti 49th √ Umum 18/09/2017 Tumor manus Excisi Tumor manus dr.Bambang Masker I/TC
152 410834 Ny.Tiyani 67th √ Umum CKD AV shunt CKD dr.Hernowo LA RJ
153 411660 Ny.Ika Agustini 23th √ Umum FAM Excisi FAM dr.Hernowo TIVA III/TC
154 411667 Sdr.Yoni Fajar P 25th √ Umum Tumor zigoma Excisi Tumor zigoma dr.Hernowo TIVA II/TC
155 407121 Ny.Siti Saroh 51th √ Umum FCD mamae Excisi FCD mamae dr.Hernowo TIVA II/TC
156 373355 Ny.Nur Nazulia 31th √ Obgyn G2P1A0+PROM+BSC LSCS+Insersi IUD G2P1A0+PROM+BSC dr.Umi SAB II/VK
157 409009 Ny.Novita Sari 30th √ Obgyn G2P1A0+PPM+BSC LSCS G2P1A0+PPM+BSC dr.Umi SAB II/VK
158 395708 Ny.Silvi Rahma 22th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
159 409719 Ny.Jenny Krisna 27th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
G2P1A0+oligohidramnion+B G2P1A0+oligohidramnion+B
160 409280 Ny.Weni Artanti 31th √ Obgyn SC LSCS SC dr.Umi SAB II/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
161 384081 Ny.Kisworini 29th √ Obgyn 18/09/2017 G4P1A1+haemoroid LSCS G4P1A1+haemoroid dr.Umi SAB III/VK
Cistoma ovarii S+cista para
162 409053 Ny.Lucia Sri K 48th √ Obgyn Cistoma ovarii SOS ovum dr.Umi SAB III/VK
163 373619 Ny.Ritnawati 28th √ Obgyn 19/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
164 367667 Ny.Arum Fajar 25th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB III/VK
165 412288 Ny.Irmayani 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
166 217526 Ny.Jawarul Husni 51th √ Umum Nekosis digiti IV-Vpsdis D Amputasi Nekosis digiti IV-Vpsdis D dr.Sukarno SAB VVIPA

167 400306 Ny.Anita Wulan 28th √ Obgyn G1P0A0+high miopi LSCS G1P0A0+high miopi dr.Haris SAB II/VK
168 404017 Ny.Fitriya H 28th √ Obgyn G6P5A1+PPT LSCS G6P5A1+PPT dr.Haris SAB III/VK
169 352678 Ny.Mariyah 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
170 411067 Ny.Siti Aisah 46th √ Obgyn Mioma uteri+cistoma ovarii SVH+BSO Mioma uteri+cistoma ovarii dr.Haris SAB II/VK
Super
171 412126 Tn.M.Ali Fikri 48th √ Umum Celulitis cruris D Incisi Celulitis cruris D dr.Sukarno SAB VVIP
172 410846 Ny.Diah Ayu S 37th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
173 313351 Tn.A.M.Hadi 59th √ Umum Abses cruris D Multiple incisi Abses cruris D dr.Hernowo SAB I
Multiple mioma+cistoma
174 303563 Ny.Jumainah 49th √ Obgyn Miomauteri SVH+SOD ovarii D dr.Kery SAB III/VK
175 173599 Ny.Kusnul K 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
176 412123 Ny.Rita Annisa 25th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB PAV
177 286603 Ny.Tutik W 56th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA I
178 084121 Ny.Hj.Mujiati 53th √ Ortho Ganglion carpi Exterpasi Ganglion carpi dr.Hari C Masker VVIPB
179 412331 Sdr.SamsulArifin 29th √ Umum Haemoroid G IV Haemoroidectomy Haemoroid G IV dr.Sukarno SAB I
180 407876 Ny.Uswatun H 27th √ Obgyn G2P1A0+high miopi LSCS G2P1A0+high miopi dr.Umi SAB III/VK

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
181 410834 Ny.Tiyani 67th √ Anestesi 19/09/2017 CKD Pasang CVC CKD dr.Ary F LA III/TC
182 365867 Ny.Jainem 50th √ Obgyn Cistoma ovarii SOS Cistoma ovarii dr.Umi SAB III/VK
183 407571 Ny.Ika Yudistari 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
184 405826 Ny.Ernawati 34th √ Obgyn 20/09/2017 G3P1A0+PP LSCS G3P1A0+PP dr.Kery SAB II/VK
185 324817 Ny.Ijun Surya 32th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB III/VK
186 410071 Ny.Lailatul Fitria 44th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
187 197778 Ny.Choirul Anam 42th √ Obgyn Mioma uteri SVH+SOS Multiple mioma uteri dr.Kery SAB I/VK
Cistoma ovarii
188 410862 Ny.Cicis Herawati 58th √ Obgyn Cistoma ovarii SOS+release perlengketan permagna+perlengketan dg dr.Kery SAB II/VK
collon
189 322818 Ny.Ervani Aprilia 26th √ Obgyn Erosi portio Couter Erosi portio dr.Kery SAB II/VK
190 207127 Tn.Abdul Nasser 60th √ Umum Basalioma hidung Wide incisi Basalioma hidung dr.Sukarno Intubasi I
191 409458 Ny.Yuli Ratna A 27th √ Umum FAM Excisi FAM dr.Hernowo TIVA II
192 412273 Ny.Wulansari 29th √ Umum FAM Excisi FAM dr.Hernowo TIVA II
193 411391 Ny.Kamilatul K 35th √ Umum FAM Excisi FAM dr.Hernowo TIVA III/TC
194 412287 Tn.Siswo Hadi 40th √ Umum Tumor dinding dada Excisi Tumor dinding dada dr.Hernowo TIVA I/TC
195 259418 NY.Nurma Susanti 29th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Umi SAB II/VK
196 410656 Tn.Heri Santoso 43th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA II
197 263232 Ny.Sulasmi 34th √ Umum Ca tiroid Total lobectomy Ca tiroid dr.Hernowo Intubasi II
198 405078 Ny.Yeni Mayasari 34th √ Obgyn G3P2A0+nst non reaktif LSCS G3P2A0+nst non reaktif dr.Umi SAB I/VK
199 317163 Ny.Sri Murtini 36th √ Obgyn G5P3A1+BSC LSCS+MOW G5P3A1+BSC dr.Umi SAB II/VK
200 334146 Ny.Badiatul K 38th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
201 261736 Tn.Budi Astajarja 46th √ Ortho 20/09/2017 Cl fr radius S Orig pining Cl fr radiuys S dr.Hari C Intubasi II/TC
202 366217 Ny.Eka Wahyu S 32th √ Obgyn G2P0A1+Oligohidramnion LSCS G2P0A1+Oligohidramnion dr.Umi SAB II/VK
203 412498 Ny.Izzatul Intan 25th √ Obgyn 22/09/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
204 412493 Ny.Dwi Sulistio 28th √ Umum Atheroma pipi Exterpasi Atheroma pipi dr.Sukarno TIVA II/TC
205 412249 Ny.Weni Nur R 30th √ Umum FAM Exterpasi FAM dr.Sukarno Masker II
206 281991 Ny.Antunia Ratih 33th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II
207 242271 Ny.Kasmini 53th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA RJ
208 292653 Ny.Rita Retna 35th √ Obgyn G4P1A3+Post SOD LSCS G4P1A3+Post SOD dr.Kery SAB II/VK
209 398480 Ny.Betsyba Yuli 32th √ Obgyn G3P2A0+PPT LSCS G3P2A0+PPT dr.Umi SAB I/VK
210 359125 An.Alkalifi H 1th √ Umum HIL Herniotomy HIL dr.Hernowo Masker I
211 248429 Ny.Riwahty Tandi 58th √ Umum Appendicitis kronic Appendictomy Appendicitis kronic dr.Hernowo SAB I
212 412557 Ny.Diah Sulistio 49th √ Ortho Cl Fr tibia fibula Orif plating Cl Fr tibia fibula dr.Hari C SAB II/TC
213 412558 Tn.M.Yusuf 26th √ Ortho Cl Fr clavicula Orif plating Cl Fr clavicula dr.Hari C Intubasi II/TC
214 412626 Ny.Ikvina Abdiya 20th √ Obgyn 23/09/2017 G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB III/VK
215 412535 Tn.M.Zar Nahrawi 43th √ Ortho Cl Fr Clavicula Orif plating Cl Fr Clavicula dr.Hari C Intubasi II/TC
216 412624 Sdr.Khoirul Umam 21th √ Ortho Finger tinger injuri digiti III Debridement Finger tinger injuri digiti III dr.Hari C Masker III/TC
217 412614 Tn.Aries Susanto 40th √ Umum Appendicitis kronic Appendictomy Appendicitis kronic dr.Hernowo SAB II
218 408838 Ny.Nanda Yulia 19th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB III/VK

219 412663 Ny.Galuh Puspita 26th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
G2P1A0+HT+Kelainan G2P1A0+HT+Kelainan
220 144872 Ny.Muthawifah 42th √ Obgyn kongenital LSCS kongenital dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
221 411262 Ny.Ruly Ekawati 34th √ Obgyn 14/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
222 411919 Ny.Ismini 47th √ Obgyn Condiloma akuminata Couter Condiloma akuminata dr.Umi SAB II/VK
223 198544 Ny.Dewi Anis S 31th √ Obgyn 25/09/2017 G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Haris SAB I/VK
224 412222 Ny.Atik Kumala 35th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
225 412769 Ny.Saroh Asiah 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
226 404280 Ny.Inna Kurniawati 34th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Umi SAB II/VK
227 335625 Ny.Ermawati 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
228 281273 Ny.Nur Ainiyah 53th √ Umum Lipoma cruris Excisi Lipoma cruris dr.Bambang SAB III/TC
229 355062 Ny.Mukinah 48th √ Umum Abces punggung Incisi+debridement Abces punggung dr.Bambang TIVA III/TC
230 411806 Ny.Suparmi 54th √ Umum Tumor axilla Excisi Giant lipoma dr.Hernowo TIVA III/TC
231 412586 Nn.Desi Fransisca 23th √ Umum Tumor antebrachii Excisi Tumor antebrachii dr.Hernowo TIVA II
232 202096 Ny.Satumi 55th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
233 412760 Tn.M.Erfan 29th √ Umum Appendicitis akut Laparatomy appendictomy Appendicitis perforasi dr.Hernowo SAB II
234 293906 Ny.Setyo Rini 48th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
235 316933 Tn.Darip 54th √ Anestesi CKD Pasang double lumen CKD dr.Ary F LA RJ
236 412309 Ny.Djumini 54th √ Anestesi CKD Pasang double lumen CKD dr.Ary F LA RJ
237 408527 Ny.Erny Oktavia 34th √ Obgyn G4P1A2+BSC LSCS+insesrsi IUD G4P1A2+BSC dr.Umi SAB II/VK
238 181919 Ny.Nihla Fitriani 30th √ Obgyn G2P1A0+BSC LSCS+insesrsi IUD G2P1A0+BSC dr.Umi SAB I/VK
Nuoplasma ov kistic susp
239 411941 Nn.Tabita Rahma 23th √ Obgyn Cistoma ovarii SOS ganas dr.Umi SAB III/VK
240 401558 Ny.Shofiyah 33th √ Obgyn G2P1A0+KIFL+PEB LSCS Widya Silvia dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
241 412791 An.Dara Auliya 8th √ Umum 26/09/2017 Hemangioma paha Excisi Hemangioma paha dr.Sukarno TIVA I
242 412337 Sdr.Azriel Yogi 15th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II
243 287900 Ny.Reza Diah O 26th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II
244 412811 Ny.Nurul Novita 20th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Kery SAB III/VK
245 412854 Ny.Vita Kumala 21th √ Obgyn G1P0A0+Gemelli LSCS G1P0A0+Gemelli dr.Kery SAB II/VK
246 291498 Ny.Dwi Masruloh 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
247 257211 Ny.Siti Ulfa 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
248 238664 Ny.Khusnul Chuluq 29th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Kery SAB III/VK
249 412571 Nn.Widya Silvia 20th √ Obgyn Condiloma Couter Condiloma dr.Kery SAB III/VK
250 412866 Ny.Sri Wahyu 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
251 412514 Ny.Kariyati 54th √ Umum Perianal abses Incisi+debridement Perianal abses dr.Hernowo SAB II
252 412774 Ny.Sunanik S 40th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB III
253 407682 Ny.Andita Ferlinda 27th √ Obgyn G1P0A0+post term LSCS G1P0A0+post term dr.Umi SAB II/VK
Kehamilan ektopik tuba pars
254 412911 Ny.Anindya P 23th √ Obgyn Kehamilan ektopik Salpingectomy D infundibular dr.Umi SAB II/VK
255 411965 Tn.Sulistyono 62th √ THT Tumor auricle Excisi Tumor auricle dr.Noer S TIVA III/TC
256 412967 Ny.Cici Kurnia 26th √ Obgyn G2P0A1+NST non reaktif LSCS G2P0A1+NST non reaktif dr.Haris SAB III/VK
257 412793 Nn.Mita Dwi 15th √ Umum 27/09/2017 Tumor gluteus Exterpasi Tumor gluteus dr.Sukarno TIVA III/TC
258 173595 Ny.Nurul Wahyuni 36th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
259 236452 Ny.Elly Kusmarini 33th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
Peritonitis
260 288747 Tn.A.Rofiq 46th √ Umum Appendicitis akut Lap appendictomy genarisataappendic dr.Sukarno SAB II
perforasi
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI √
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
261 411633 Ny.Eli Ermayanti 30th √ Obgyn 27/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
262 411088 Ny.Titin Atmayanti 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
263 408725 Ny.Samsiyah 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
264 412572 Ny.Finda Setyani 28th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
265 357821 Ny.Ferny Kurnia 45th √ Obgyn Mioma uteri SVH+SOS Mioma uteri dr.Kery SAB III/VK
266 412941 Tn.Yahya S 47th √ Anestesi CKD Pasang double lumen CKD dr.Ary F LA RJ
267 222677 Ny.Minhawa F 36th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Heru B SAB I/VK
268 411441 Ny.Wahyuniati 36th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
269 396221 Ny.Supriati 62th √ Umum Ganglion pedis Excisi Ganglion pedis dr.Hernowo SAB II
270 262786 Tn.Sochib 57th √ Umum Abces genue Multiple incicsi Abces genue dr.Hernowo SAB II/TC
271 186460 Ny.Silvia Indawati 32th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB I/VK
272 407424 Ny.Pipit Krisna 22th √ Obgyn G2P1A0+Oligohidramnion LSCS G2P1A0+Oligohidramnion dr.Umi SAB II/VK
273 412530 Ny.Retno Purna 24th √ Obgyn 28/09/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

274 413120 Ny.Nisfaul Laili 27th √ Obgyn G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Kery SAB II/VK
275 413014 Ny.Suci Indarti 43th √ Umum Abces labia Incisi+debridement Abces labia dr.Bambang SAB III
276 413085 Ny.Yeny Noer Y 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
277 400299 Ny.Ary Yuana 40th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Kery SAB II/VK
278 412757 Ny.Sudarsih 41th √ Ortho Cl fr colles D Psg gips+reposisi Cl fr colles D dr.Danang TIVA II/TC
Excisi+curetage+bone
279 000159 Ny.Tri Resti J 45th √ Ortho Bone tumor mc III S grafiting Bone tumor mc III S dr.Danang Intubasi VVIPA
280 329299 Ny.Nira Yuliana R 36th √ Obgyn G2P1A0+PROM+Letsu LSCS G2P1A0+PROM+Letsu dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
281 298299 Sdr.Esa Andriyan 23th √ Ortho 28/09/2017 Cross injuri digiti V manus D Debridement+pining Cross injuri digiti V manus D dr.Danang Masker II/TC
282 301474 Ny.Ariyani 31th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB II/VK
283 222418 An.Dandi Putra 14th √ Ortho Op fr digiti II pedis Debridement+pining Op fr digiti II pedis dr.Danang SAB II/TC
284 294451 Tn.Suriyono 62th √ Umum Nekrosis digiti pedis Amputasi+debridement Nekrosis digiti pedis dr.Hernowo SAB II
285 374900 Tn.Seger 59th √ Umum 29/09/2017 HIL Laparatomy herniotomy HIL dr.Hernowo SAB III
286 076409 Tn.Purwanto 77th √ Umum HIL Residif Herniotomy HIL Residif dr.Hernowo SAB III
287 375651 Ny.Dyah Laksmita 36th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II
288 413031 Ny.Rochima R 43th √ Umum Haemoroid externa Haemoroidectomy Haemoroid externa dr.Bambang SAB II/TC
289 412999 Ny.Nur Aini 33th √ Umum Ganglion pedis Excisi Ganglion pedis dr.Bambang SAB II/TC
290 354437 Ny.Eka Kenny R 36th √ Umum Appendicitis Appendictomy Appendicitis dr.Bambang SAB II/TC
291 413152 Sdr.Fariz Ardian 26th √ Ortho Cl fr radius 1/3 distal Orif plating Cl fr radius 1/3 distal dr.Danang Intubasi VVIPB
Union fr radiusulna post Union fr radiusulna post
292 358602 Ny.Lucky Indayani 33th √ Ortho plating Aff plate plating dr.Danang Masker II
293 230055 Ny.Ellyana 37th √ Umum 30/09/2017 Abses axilla Incisi+debridement Abses axilla dr.Bambang TIVA I
294 413188 Ny.Sukiati 57Th √ Anestesi CKD std V pasang CVC ,double lumen CKD std V dr.Ary LA III
295 286603 Ny.Tutik Wilujeng 56th √ Anestesi CKD std V pasang CVC ,double lumen CKD std V dr.Ary LA I
296 412815 Tn.Suhudi 66th √ √ Umum Ulkus Pedis debridement Ulkus Pedis dr.Hernowo SAB III
297 237747 Tn.Wibowo Eko 48th √ Umum Nekrosis dgt IV pedis debridement + AmputasiNekrosis dgt IV pedis dr.Hernowo SAB II
298
299
300

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN SEPTEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
L P KH B S K HESI
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
3/I √ √ √

2/I √ √ √

1/I √ √ √

4/I √ √ √

2/II √ √ √

3/III √ √ √

1/I √ √ √

3/I √ √ √
1/I √ √ √
4/I √ √ √

3/I √ √ √

2/I √ √ √

1/II √ √ √

2/II √ √ √
1/II √ √ √

1/III √ √ √

2/III √ √ √

3/II √ √ √

3/I √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

2/III √ √ √

3/III √ √ √

1/I √ √ √

4/I √ √ √

4/II √ √ √
2/II √ √ √

1/III √ √ √

2/III √ √ √

4/II √ √ √

3/III √ √ √

1/III √ √ √

1/II √ √ √

1/I √ √ √

3/I √ √ √

4/I √ √ √

4/II √ √ √

3/II √ √ √

2/II √ √ √

2/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
2/III √ √ √

3/III √ √ √

3/IV √ √ √

1/III √ √ √

4/I √ √ √

2/III √ √ √

1/IV √ √ √

2/IV √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

2/II √ √ AIA
3/III √ √ √
1/II √ √ √
2/III √ √ √
1/III √ √ √

2/IV √ √ √
1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/IV √ √ √

2/IV √ √ √

3/I √ √ √
adme
1/I √ √ dika
2/I √ √ √

4/I √ √ √

3/II √ √ √

2/II √ √ √

3/II √ √ √

1/I √ √ √

2/I √ √ √
3/II √ √ √

2/II √ √ √

3/III √ √ √

3/I √ √ √

2/I √ √ √

2/I √ √ √

1/I √ √ √

1/II √ √ RBH
2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/III √ √ √

2/II √ √ √
4/I √ √ √

1/III √ √ √

4/II √ √ √

3/III √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ JAI
3/I √ √ √

3/II √ √ √

1/I √ √ √

2/II √ √ √

4/I √ √ √

3/III √ √ √

2/III √ √ √

4/II √ √ √

1/II √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

3/I √ √ √

3/II √ √ √

4/I √ √ √

1/I √ √ √

1/II √ √ √

2/III √ √ √

3/III √ √ √

3/IV √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

3/I √ √ √

4/I √ √ √
2/II √ √ √

1/I √ √ √

2/III √ √ √

3/III √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

3/IV √ √ √

3/V √ √ √

2/IV √ √ √

1/III √ √ √

4/I √ √ √

1/II √ √ √
3/I √ √ √

2/I √ √ √

2/I √ √ √

1/I √ √ √

2/II √ √ √

2/III √ √ √

4/I √ √ √

3/I √ √ √

2/III √ √ √

3/II √ √ √

2/IV √ √ √

1/III √ √ √

1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

1/III √ √ √

3/I √ √ √

4/I √ √ √

2/I √ √ √

3/II √ √ √

2/I √ √ √

2/II √ √ √

2/I √ √ √

1/I √ √ √

2/I √ √ √

4/I √ √ √

2/II √ √ √

2/III √ √ √

1/I √ √ √

2/III √ √ √

1/II √ √ √

2/V √ √ √

2/IV √ √ √
1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ JAI
2/VI √ √ √

1/I √ √ JAI
2/I √ √ √

2/II √ √ √

1/III √ √ √

3/I √ √ √

3/III √ √ √

2/III √ √ √

4/I √ √ √

1/IV √ √ √
1/II √ √ √

1/I √ √ √

4/II √ √ √

3/IV √ √ √

2/III √ √ √

RR √ √ √

2/IV √ √ √

1/III √ √ √

2/V √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
RR √ √ √

3/IV √ √ √

2/IV √ √ √
4/II √ √ √

3/I √ √ √

3/II √ √ JAI
2/I √ √ √

3/III √ √ √

1/IV √ √ √

4/I √ √ √

2/II √ √ √

1/I √ √ √

1/II √ √ √

2/IV √ √ √

3/IV √ √ √

RR √ √ √

2/IV √ √ √

3/V √ √ √

1/III √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/IV √ √ √

3/VI √ √ √

2/I √ √ √

1/I √ √ √ √

2/II √ √ √

3/I √ √ √

RR √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ √

1/I √ √ √

4/I √ √ ADMEDIKA
4/II √ √ ADMEDIKA
3/I √ √ √
Kete
naga
4/I √ √ kerja
an
2/I √ √ √

1/I √ √ √

3/II √ √ √

2/I √ √ √

2/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

1/II √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

2/II √ √ √

3/III √ √ √
1/II √ √ RBH
4/I √ √ √

3/III √ √ √

2/III √ √ √

1/II √ √ √

2/IV √ √ √

RR √ √ √

RR √ √ √

3/IV √ √ √

4/II √ √ √

3/IV √ √ √

4/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

3/II √ √ √

2/I √ √ JAI
2/II √ √ √

3/III √ √ √

1/IV √ √ √

2/III √ √ √

1/III √ √ √

2/IV √ √ √

3/I √ √ √

2/IV √ √ √

2/V √ √ √

2/I √ √ √

1/I √ √ √

3/I √ √ √

2/I √ √ √

1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

2/II √ √ √

3/II √ √ √

3/III √ √ √

2/III √ √ √

RR √ √ √

3/IV √ √ √

4/II √ √ √

1/II √ √ √

1/III √ √ √

3/IV √ √ √

2/IV √ √ √
1/I √ √ √

2/I √ √ √

1/II √ √ √

2/II √ √ √

3/I √ √ √

1/II √ √ comfeed
4/I √ √ RSI
3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/II √ √ ketenagakerjaan
3/IV √ √ √

4/III √ √ √

1/III √ √ √
2/II √ √ √

2/I √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

3/II √ √ √

4/I √ √ ketenagakerjaan
4/II √ √ ketenagakerjaan
1/I √ √ √

4/I √ √ √

4/II √ √ √

1/II √ √ √

12/III √ √ √

Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA
ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 269648 Ny.Fanny Dwi S 27th √ Obgyn 10/1/2017 G4P2A1+BSC LSCS G4P2A1+BSC dr.Kery SAB II/VK
2 231636 Ny.Ria Yeni S 32th √ Obgyn 02/10/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK

3 397700 Ny.Yayuk Trisna 23th √ Obgyn G1P0A0+high miopi LSCS G1P0A0+high miopi dr.Heru B SAB I/VK
4 378227 Ny.Suyatmi 42th √ Obgyn G5P1A3+HSVB LSCS G5P1A3+HSVB dr.Haris SAB II/VK
5 250778 Ny.Sukariyasih 28th √ Obgyn G4P2A1+BSC LSCS G4P2A1+BSC dr.Haris SAB II/VK
6 413355 Ny.Wiwik Hidayati 37th √ Obgyn G4P2A1+Haemoroid LSCS G4P2A1+Haemoroid dr.Haris SAB II/VK
7 307481 Ny.Lianti Ratna 36th √ Obgyn Cistoma ovarii Miomectomy+SOD Ciste coklati+mioma uteri dr.Haris SAB III/VK
8 413380 Ny.Lailatul Q 35th √ Obgyn G4P2A1+PROM LSCS+MOW G4P2A1+PROM dr.Umi SAB I/VK
9 412919 Ny.Heni Riwayati 33th √ Umum Basalioma zigoma Excisi Basalioma zigoma dr.Hernowo TIVA II
10 411093 Ny.Rumisih 45th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
11 270001 Ny.Lia Indah S 27th √ Umum Tumor supra simpisis Excisi Tumor supra simpisis dr.Hernowo SAB II

12 413182 Tn.Liem Sioe G 69th √ Umum Tumor pipi Excisi Tumor pipi dr.Bambang TIVA I

13 413184 An.Wildan Abdi M 14th √ Umum Appendicitis Appendictomy Appendicitis dr.Bambang SAB II
14 412638 Tn.Ach. Sultoni 55th √ Umum Tumor cruris S Excisi Tumor cruris S dr.Hernowo SAB II
15 412582 Ny.Nikma M 31th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
16 410997 Ny.Mirna Febrian 27th √ Obgyn G1P0A0+PEB LSCS+Insesrsi IUD G1P0A0+PEB dr.Umi SAB I/VK
17 243094 Ny.Dwi Ratna N 29th √ Obgyn G3P1A1+BSC LSCS+Insesrsi IUD G3P1A1+BSC dr.Umi SAB I/VK
18 359982 Ny.Herlina 31th √ Obgyn G3P1A1+PEB LSCS+Insesrsi IUD G3P1A1+PEB dr.Umi SAB II/VK
19 412988 Ny.Novita Maya 26th √ Obgyn G1P0A0+Floating head LSCS G1P0A0+Floating head dr.Umi SAB II/VK

20 249360 Ny.Asnanik 38th √ Obgyn 03/10/2017 G3P1A1+Letak lintang LSCS G3P1A1+Letak lintang dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 171047 Ny.Budi Rahayu 34th √ Obgyn 03/10/2017 G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Kery SAB I/VK
22 254177 Ny.Siti Ngaisah 39th √ Obgyn G6P2A3+BSC LSCS+MOW G6P2A3+BSC dr.Kery SAB II/VK
23 396431 Ny.Mirawati 35th √ Obgyn G3P1A1+PP LSCS G3P1A1+PP dr.Kery SAB III/VK
Ovarium lengket dg
24 182513 Ny.Risti Rahayu 42th √ Obgyn Cistoma ovarii Cistectomy+omentectomy
omentum tuba kiri buntu dr.Kery SAB II/VK
25 413481 Ny.Dwi Hartini 43th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
26 413163 Ny.Maya Cristina 27th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB II/VK
27 225177 Ny.Mucholifah 41th √ Obgyn Mioma uteri+giborn miom SVH+BSO Mioma uteri+giborn miom dr.Haris SAB VVIPA

28 413406 Ny.Faridah 27th √ Umum Mamae abrant Excisi Mamae abrant dr.Sukarno Masker I
29 237669 Tn.Sudjojo 52th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II
G1P0A0+KPP+ket
30 413510 Ny.Siti Rachma 32th √ Obgyn G1P0A0+KPP LSCS meconeal dr.Umi SAB II/VK
31 288137 Tn.Nur Hadi 52th √ √ Umum CKD AV Shunt Mioma uteri dr.Hernowo LA RJ
32 330551 Tn.Darto 38th √ Umum Tumor pedis Excisi G1P0A0+PROM dr.Hernowo SAB III
33 413069 Tn.Abd.Safi 37th √ Urologi Varicocle Vasoligasi tinggi palomo S Mioma uteri+giborn miom dr.Kristianto SAB III/TC
34 256066 Ny.Ratih Ika P 26th √ Obgyn Abortus incomplit Curetage+Insesrsi IUD Mamae abrant dr.Heru B SAB III/VK
35 412528 Ny.Suci Aprilianti 27th √ Obgyn G1P0A0+PEB LSCS HIL dr.Umi SAB I/VK
36 394158 Ny.Wulan Indah 25th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Umi SAB II/VK
37 413591 Ny.Khoirun Nisa 24th √ Obgyn 04/10/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK

38 396263 Ny.Linda Erica 32th √ Obgyn G3P2A1+Cistoma ov LSCS+MOW G3P2A1 dr.Kery SAB II/VK
39 407587 Ny.Puspa Veruni 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
40 412780 Ny.Dewi Lestari 34th √ Obgyn G3P2A1+BSC LSCS+MOW G3P2A1+BSC dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 412000 Ny.Siti Ma'rifah 43th √ Obgyn 04/10/2017 Mioma uteri SVH+SOD mioma uteri+cistoma ovarii dr.Kery SAB VVIPA

42 412792 Ny.Rilla Andini F 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
43 413506 Ny.Susilowati 37th √ Umum FAM Excisi FAM+Ateroma mamae dr.Sukarno Masker II/TC
44 384067 Ny.Mariya Mufid 22th √ Obgyn G1P0A0+post ciste LSCS G1P0A0+post ciste dr.Haris SAB II/VK
45 369645 Ny.Yulinda Dwi 26th √ Obgyn G1P0A0+PPLR LSCS+Insersi IUD G1P0A0+PPLR dr.Umi SAB II/VK
46 413012 Tn.Duta 31th √ Umum Abses femur Multiple incisi Abses femur dr.Hernowo SAB I/TC
47 411636 Ny.Semi Rahma 31th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
48 413334 Tn.Gufarman 74th √ Ortho Cl fr colllum femur Orif screwing Cl fr colllum femur dr.Danang SAB VVIPB
Plating mandibula+suspensi
49 228477 Ny.Masudah 44th √ Umum Fr maxilla mandibula maxilla
Fr maxilla mandibula dr.Hernowo IntubasI VVIPA
50 391044 Ny.Mimik Yuliani 38th √ Obgyn Bartolinitis Kistectomy Kista bartolinitis dr.Umi SAB III/VK
51 413608 Ny.SitiAminah 38th √ Obgyn Missed abortion Curetage Mola hidatidosa dr.Umi SAB II/VK
52 413414 Ny.Elvin Kurnia 37th √ Obgyn G4P2A1+Letsu LSCS+MOW G4P2A1+Letsu dr.Umi SAB I//VK
53 404280 Ny.Inna Kurnia 34th √ Obgyn 05/10/2017 Late HPP Curetage+SVH Late HPP dr.Umi SAB II/VK
54 413679 Ny.Yessi Puspita 25th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Kery SAB I/VK
55 413680 Ny.Rinastia 26th √ Obgyn G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Kery SAB II/VK
56 413360 Ny.Jumrotin 42th √ Obgyn Mioma uteri Miomectomy+SOS Mioma uteri dr.Kery SAB III/VK
57 413124 Ny.Ririn A 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
58 338722 Ny.Santika Gracia 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
59 402434 Nn.Hidayatul M 18th √ Umum FAM Excisi FAM dr.Hernowo Masker II/TC
60 409451 An.Disa Sahputra 5th √ Umum Ganglion poplitea Excisi Ganglion poplitea dr.Hernowo Masker II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 413641 An.Ranie Izza 3th √ Umum 05/10/2017 Hemangioma Excisi Hemangioma dr.Bambang Masker III/TC
62 413640 Ny.Siti Rohilla 40th √ Umum Tumor mamae Excisi Tumor mamae dr.Bambang TIVA III/TC
63 413637 Tn.Chasim Arifin 52th √ Umum HIL Herniotomy HIL dr.Bambang SAB III/TC
64 386003 Tn.Abdul Jamil 62th √ Umum Abces punggung Incisi+debridement Abces punggung dr.Bambang Masker I/TC

65 407348 Tn.Budiono 66th √ Urologi BPH TUR-P BPH dr.Kristianto SAB III/TC
66 387769 Ny.Siti Maslukah 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
67 333530 Ny.Tri Ratna E 38th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
68 403135 Ny.Novi Susanti 28th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
69 413557 Sdr.M.Khoirul Amni 17th √ Ortho Cl fr femur 1/3 tengah Orif plating Cl fr femur 1/3 tengah dr.Danang SAB II/TC
70 413515 Ny.Luluk Ajidah 35th √ Obgyn 06/10/2017 G3P1A0+BSC LSCS G3P1A0+BSC dr.Umi SAB II/VK
71 242271 Ny.Kasmini 59th √ Anestesi CKD Pasand double lemen CKD dr.Ary LA RJ
72 413144 Ny.Sri Ratna 66th √ Anestesi CKD Pasand double lemen CKD dr.Ary LA VVIPB

73 236778 Nn.Lailil Hudaibi 20th √ Bdh plastik Bad scar mentum Repair bad scar Bad scar mentum dr.Ariek Intubasi III
74 394216 Ny.Oktavia Ayu 27th √ Umum Ca mamae Mastectomy Ca mamae dr.Bambang Intubasi II/TC
75 413474 Tn.Suharsono 49th √ Umum Tumor frontal Excisi Tumor frontal dr.Hernowo TIVA II
76 243729 Ny.Sudarti 47th √ Umum Ca mamae MRM Ca mamae dr.Hernowo Intubasi II
77 253575 Ny.Indah Yulia P 36th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo Intubasi I
78 413791 An.M.Fauzan A 11th √ Umum Appendicitis acut Appendictomy Appendic perforasi dr.Hernowo SAB II
79 413835 Ny.Siti Mariyam 34th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Umi SAB II/VK
80 413727 Ny.Muayah 64th √ Umum Multiple abces inguinal Incisi+debridement Multiple abces inguinal dr.Hernowo SAB II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B √ K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 412439 Ny.Maisyah 29th √ Obgyn 06/10/2017 G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB III/VK
82 301828 Ny.Yenny Devita 33th √ Obgyn G3P1A0+BSC LSCS G3P1A0+BSC dr.Umi SAB II/VK
83 412345 Ny.Fitri Utami 38th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB II/VK
84 366679 Sdr.Setyo Adi N 30th √ Umum 10/7/2017 Multiple tumor pipi Multiple excisi Multiple tumor pipi dr.Bambang TIVA I/TC
85 413816 Tn.Kusnan 62th √ Umum HIL Herniotomy HIL dr.Bambang SAB III/TC
86 233525 Ny.Subatin 42th √ Obgyn IUFD Curetage IUFD dr.Kery SAB II/VK
87 413438 Tn.Usman Muktar 50th √ Urologi Abces scorotal Multiple incisi abces scorotal Abces scorotal dr.Kristianto SAB I
88 413857 An.Crolavina B 7th √ Ortho Fr condilar lateral humerus Orif pining Fr condilar lateral humerus dr.Hari C Intubasi III/TC
89 389173 Ny.Siti Masulah 31th √ Obgyn G2P1A0+Letsu LSCS+Insersi IUD G2P1A0+Letsu dr.Umi SAB II/VK
90 413952 Ny.Mia Dwi J 20th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK

91 411341 Ny.Tsalis Maida 38th √ Obgyn G4P2A1+BSC LSCS G4P2A1+BSC dr.Umi SAB I/VK
92 379816 Ny.Octilysari W 32th √ Obgyn Bligted ovum Curetage Bligted ovum dr.Umi SAB II/VK
93 413694 Ny.Dian Purwita 28th √ Obgyn 08/10/2017 G1P0A0+Visus -6 LSCS G1P0A0+Visus -6 dr.Kery SAB II/VK
94 266423 Ny.Ikawati 42th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Kery SAB I/VK
95 405559 Ny.Dhika Wulan 28th √ Obgyn G1P0A0+Gemelli LSCS G1P0A0+Gemelli dr.Kery SAB I/VK
96 376002 Ny.Maratus 23th √ Obgyn G1P0A0+Fetal distress LSCS G1P0A0+Fetal distress dr.Kery SAB II/VK
97 412307 Ny.Siti Nadia 26th √ Obgyn G3P1A0+Letsu LSCS G3P1A0+Letsu dr.Kery SAB II/VK
98 413755 Ny.Siti Zubaidah 57th √ Umum 09/10/2017 Ganglion pedis Excisi Ganglion pedis dr.Sukarno SAB I/TC
99 160534 Ny.Siti Ma'munah 48th √ Umum Tumor leher Exterpasi Tumor leher dr.Sukarno TIVA II
100 287808 Tn.Abd.Manab 49th √ Umum HIL Herniotomy HIL dr.Sukarno SAB II/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
101 413982 Tn.Ridwan 67th √ Anestesi 09/10/2017 CKD Pasang doble lumen CKD dr.Ary LA VVIPB

102 210255 Ny.Diah Prawito 38th √ Anestesi CKD Pasang doble lumen CKD dr.Ary LA RJ
103 316933 Tn.Darip 56th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
104 379071 Ny.Sukesih 53th √ Umum Ganglion wrist Excisi Ganglion wrist dr.Hernowo Masker II
105 413901 Ny.Komariyah 31th √ Umum Lipoma punggung Excisi Lipoma punggung dr.Hernowo TIVA I
106 413432 Tn.Imam Sugeng 56th √ Umum HIL Herniotomy HIL dr.Hernowo SAB II
107 331009 Ny.Siti Khomaria 31th √ Obgyn G4P1A3+PROM LSCS G4P1A3+PROM dr.Umi SAB II/VK
108 364458 Ny.Umi Latifah 34th √ Obgyn G4P2A1+BSC LSCS+Insesrsi IUD G4P2A1+BSC dr.Umi SAB II/VK
109 396507 Ny.Kurniasari 31th √ Obgyn G2P1A0+PEB+BSC LSCS+Insesrsi IUD G2P1A0+PEB+BSC dr.Umi SAB II/VK
110 414074 Ny.Asmaul Husna 38th √ Obgyn G3P2A0+PEB LSCS+MOW G3P2A0+PEB dr.Umi SAB II/VK
111 414063 Ny.Shinta Ayunda 5th √ Umum 10/10/2017 Atheroma infeksi Excisi Atheroma infeksi dr.Sukarno Masker II
112 414132 Tn.Ulil Absor 47th √ Umum Fibroma dinding thorax Exterpasi Fibroma dinding thorax dr.Sukarno TIVA II
113 324971 Tn.Abdullah 57th √ Umum Fistula ani infeksi Fistulectomy Fistula ani infeksi dr.Sukarno SAB II
114 412454 Ny.CholidatulAsma 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
115 413533 Ny.Ifa Ritnawati 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
116 413941 Ny.Nur Eniyah 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

117 414163 Ny.Siti Roudho 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
118 403593 Ny.Rini Irawati 19th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Umi SAB III/VK
119 412682 Ny.Umi Hanifah 44th √ Obgyn Mioma uteri SVH+SOS Mioma uteri dr.Kery SAB II/VK
120 414161 Ny.Oktavia Dwi 22th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP G2P1A0+BSC OPERATOR INAP
L P HESI

121 193802 Tn.Achmad Zakir 47th √ Umum 10/10/2017 Tumor gluteus Excisi Tumor gluteus dr.Hernowo SAB I

122 414173 An.Ghazy Abbiyu 8th √ Umum Appendic perforasi Lap appendictomy Appendic perforasi dr.Hernowo SAB VVIPA

123 345767 Ny.Indra Wahyu 40th √ Umum Tumor punggung Excisi Tumor punggung dr.Hernowo TIVA II

124 246471 Tn.Kadarinan 69th √ Urologi Hidrocele testis D Hidrocelectomy Hidrocele testis D dr.Kristianto SAB I

125 414192 Nn.Adisti Nur H 15th √ Umum 11/10/2017 HIL Herniotomy HIL dr.Sukarno SAB II/TC

126 302032 Tn.Arief Jukianto 46th √ Umum Fibroma dinding perut Exterpasi Fibroma dinding perut dr.Sukarno SAB I/TC

127 414197 Tn.Suratin 48th √ Umum Ganglion carpi Exterpasi Ganglion carpi dr.Sukarno Masker II/TC
128 414245 Tn.Imam Suryadi 41th √ Umum Fistula ani abces Fistulestomy Fistula ani abces dr.Sukarno SAB III

129 362950 Ny.Julaicha 35th √ Obgyn G2P1A0+Visus -8 LSCS G2P1A0+Visus -8 dr.Kery SAB III/VK

130 413413 Ny.Wahyu Nur A 27th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB II/VK
Miomectomy+SOD+release
131 407423 Ny.Purwaningsih 34th √ Obgyn Mioma uteri perlengketan
Mioma uteri+Cistoma ovarii dr.Kery SAB II/VK

132 412818 Ny.Nur Saini 49th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
Abces pedis necrosis digiti Abces pedis necrosis digiti
133 254032 Ny.Suciati 58th √ Umum III
Amputasi+debridement
III dr.Hernowo SAB I/TC

134 414164 Tn.A.Mataji 60th √ Umum HIL post inkaserata Herniotomy HIL post inkaserata dr.Hernowo SAB II/TC

135 414225 Ny.Thohiroh 34th √ Umum Appendic akut Appendictomy Appendic akut dr.Sukarno SAB II/TC

136 414068 Ny.Sukariyah 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK

137 367582 Ny.Cahya Ningrum 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK

138 411970 Ny.Lailatul Faricha 24th √ Obgyn 12/10/2017 G1P0A0+Letlin LSCS G1P0A0+Letlin dr.Kery SAB II/VK

139 342093 Ny.Thoainiyah S 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK

140 228466 Ny.Silvia K 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
141 301247 Ny.Endang Lukita 57th √ Obgyn 12/10/2017 Mioma uteri TAH+SOS Mioma uteri dr.Kery SAB II/VK
142 414395 Ny.Fitriyah 44th √ Obgyn Multiple mioma uteri SVH Multiple mioma uteri dr.Kery SAB II/VK
143 330327 Ny.Amin Flurida 41th √ Obgyn G4P3A1+Letlin+BSC LSCS+MOW+Histerectomy G4P3A1+Letlin+BSC dr.Umi SAB I/VK
144 414392 Ny.Uci Maulidah 21th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Haris SAB III/VK
145 197634 Nn.Hasnah Rahma 14th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Bambang SAB II/TC
146 414363 An.Andita Salma 10th √ Umum Abses colli Incisi+debridement Abses colli dr.Bambang TIVA II/TC
147 411044 Ny.Beta Nurha 50th √ Umum Tumor colli Excisi Tumor colli dr.Bambang TIVA I/TC
148 071119 An.Mufaricatul 13th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB VVIPB

149 299937 Ny.Nuroliyah 50th √ Umum Nekrosis digiti III pedis S Amputasi+debridement Nekrosis digiti III pedis S dr.Hernowo SAB III/VK
150 411745 Ny.Indah Kurnia 32th √ Obgyn G3P1A1+BSC LSCS+Insersi IUD G3P1A1+BSC dr.Umi SAB I/VK
151 332071 Ny.Zakia Nuris 26th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
152 411107 Ny.Ani Novita 35th √ Obgyn G2P1A0+BSC+Letsu LSCS G2P1A0+BSC+Letsu dr.Umi SAB III/VK
153 414148 Ny.Siti Ruqoiyah 35th √ Obgyn Bartholin ciste Cistectomy Bartholin ciste dr.Umi SAB II/VK
154 395928 Ny.Sukesih 34th √ Obgyn G2P1A0+PPT LSCS G2P1A0+PPT dr.Umi SAB II/VK
155 414501 Ny.Yani Kurnia 33th √ Obgyn G2P1A0+KPP LSCS G2P1A0+KPP dr.Heru B SAB II/VK
156 414223 Sdr.Iqbal Rasyid 17th √ Umum 13/10/2017 Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II/TC
157 414520 Ny.Hanifah 25th √ Obgyn G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Kery SAB VVIPA

158 414534 Tn.Widianto 36th √ Anestesi CKD Psg double lumen CKD dr.Surisno LA III
159 395903 Ny.Mei Triniah 34th √ Umum FAM Excisi FAM dr.Hernowo Masker I/TC
160 360701 Ny.Asnah 62th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB III

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
161 414179 Tn.Sunarbiyanto 27th √ Umum 13/10/2017 Haemoroid Haemoroidectomy Haemoroid dr.Bambang SAB II/TC
162 414306 Ny.Yuliana 35th √ Umum Tumor mamae Excisi Tumor mamae dr.Bambang Masker III/TC
Of fraktur phalanx digiti III Of fraktur phalanx digiti III
163 414565 Tn.Suyanto 58th √ Ortho manus D
Orif pining+debridement
manus D dr.Hari C Masker II/TC
164 412517 An.Vino randika 9bl √ Umum Phymosis Circumsisi Phymosis dr.Hernowo Masker II
165 413441 Tn.Hardiansyah 55th √ Umum Ulkus pedis D Nekrotomy+debridement Ulkus pedis D dr.Hernowo SAB III
166 414423 Sdr.Andi anwar 33th √ Ortho Post amputasi pedis S Syme amputasi Post amputasi pedis S dr.Hari C SAB III/TC
167 378306 Tn.Suherman 42th √ Umum Nekrosis digiti V pedis D Amputasi+debridement Nekrosis digiti V pedis D dr.Hernowo SAB II
168 414384 Tn.Ahmad riyadi 56th √ Umum Abses colli Incisi+debridement Abses colli dr.Hernowo TIVA III/TC
Nekrosis phalanx digiti II Nekrosis phalanx digiti II
169 222418 Sdr.Dandi putra 14th √ Ortho pedis D
Debridement+repair stamp
pedis D dr.Dananag SAB I
170 414604 Ny.Rosi damay 29th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB I/VK
171 235940 Ny.Lailil asrofa 37th √ Obgyn G4P2A1+PPT LSCS G4P2A1+PPT dr.Umi SAB II/VK
G2P1A0+PEB+ketuban
172 414605 Ny.Ainur rosida 28th √ Obgyn G2P1A0+PEB LSCS mekoneal dr.Umi SAB III/VK
173 397600 Ny.Titin suhartini 34th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
174 287661 An.vanesa firza 3th √ Obgyn Vulnus laseratum vulva Heacting vulva Vulnus laseratum vulva dr.Umi Masker II/VK
175 414702 Ny.Meiza Nur S 27th √ Obgyn 14/10/2017 G2P0A0+PROM LSCS G2P0A0+PROM dr.Kery SAB II/VK
176 278417 Ny.Retno Kumala 29th √ Obgyn 15/10/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
177 413738 Ny.Iis Suyanti 22th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
178 247797 Ny.Erma Agustini 28th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Haris SAB I/VK
179 414370 Tn.Badi 47th √ Umum Tumor punggung Excisi Tumor punggung dr.Bambang TIVA III
180 382008 Tn.Zahroni M 40th √ Umum Haemoroid Haemoroidectomy Haemoroid dr.Bambang SAB I/TC

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
181 414247 Ny.Zuhrotun M 35th √ Umum 16/10/2017 Abses gluteus Incisi drainase Abses gluteus dr.Bambang Masker III/TC
182 205611 Ny.Lailatul Fitri 21th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Bambang Masker PAV
183 414540 Sdr.M.Anjas S 20th √ Umum Tumor parotis Excisi Tumor parotis dr.Bambang TIVA III/TC
184 414688 Ny.Nur Hamidah 40th √ Obgyn HPP Curetage HPP dr.Kery SAB II/VK
185 227072 Ny.Siti Asih 59th √ Umum Abses elbow Incisi+debridement Abses elbow dr.Hernowo Masker PAV
186 412733 Ny.Umi Hanik 27th √ Umum Appendiditis akut Appenictomy Appendiditis akut dr.Hernowo SAB III
187 414821 Ny.Angky Grisdian 27th √ Obgyn G3P2A0+inf intra uteri LSCS G3P2A0+inf intra uteri dr.Umi SAB I/VK
188 333530 Ny.Tri Ratna E 38th √ Obgyn Late HPP atonia uteri Curetage+SVH Late HPP atonia uteri dr.Umi SAB II/VK
189 411143 Ny.Siti Ismaul H 31th √ Obgyn G2P1A0+BSC+PP LSCS+SVH G2P1A0+BSC+PP dr.Umi SAB II/VK
190 285193 Ny.Riptiani 36th √ Obgyn Cistoma ovarii Oovarectomy+SOD Cistoma ovarii dr.Umi SAB II/VK
191 409304 Ny.Raras S 35th √ Obgyn 17/10/2017 G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Kery SAB I/VK
192 412343 Ny.Mimia Widi 30th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK
193 385547 An.Wiki Rasya 1th √ Umum GE+vomiting kejang Vena secti GE+vomiting kejang dr.Sukarno LA II
194 414835 Nn.A'matun N 16th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Sukarno Masker II
195 413920 Ny.Sumarlik 53th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
196 341019 Ny.Lutfiah 43th √ Anestesi CKD Psg double lumen CKD dr.Ary F LA III
197 414080 Ny.Rumiati 45th √ Obgyn Mioma uteri SVH Multiple mioma dr.Kery SAB II/VK
198 218921 Ny.Nurul Ainia 31th √ Obgyn Bligted ovum Curetage Bligted ovum dr.Kery SAB II/VK
199 189626 Ny.Nailul Ifah 31th √ Obgyn G2P1A0+BSC+PP LSCS+Insersi IUD G2P1A0+BSC+PP dr.Umi SAB II/VK
200 414936 Ny.Anggi Novia 20th √ Obgyn G1P00+CPD LSCS G1P00+CPD dr.Umi SAB III/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
201 414836 Tn.Weda Surya 38th √ Ortho 17/10/2017 Cl fr clavicula 1/3 medial Orif plating Cl fr clavicula 1/3 medial dr.Hari C Intubasi II/TC
202 264052 Tn.Gideon L 37th √ THT Septum deviasi Septoplasy+turbino plsty Septum deviasi dr.Noer Sofi Intubasi II
203 386202 Ny.Liyani Agustin 33th √ Obgyn 18/10/2017 G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB II/VK
204 414979 Ny.Dewi Masitoh 30th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
205 272868 Ny.Ika Krisnawati 32th √ Obgyn G6P2A2+BSC LSCS+MOW G6P2A2+BSC dr.Kery SAB II/VK
206 414079 Ny.Eka Naning 31th √ Obgyn G3P1A1+Letsu LSCS+MOW G3P1A1+Letsu dr.Kery SAB I/VK
207 414919 Sdr.Wahyu Agus 17th √ Umum Ganglion carpi Exterpasi Ganglion carpi dr.Sukarno Masker III/TC
Peritonitis appendik
208 237182 Sdr.Icuk Sugiarto 31th √ Umum perforasi Lap appendictomy Appendik perforasi dr.Sukarno SAB II/TC
209 255342 Ny.Dian Kusuma 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
210 408498 Ny.Nur Khoiroyaro 43th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo Intubasi II
211 413889 Ny.Umi Faricha 41th √ Umum FAM S Excisi FAM S dr.Hernowo Masker III/TC
212 366881 Nn.Siti Anjani 21th √ Umum Tumor femur Excisi Tumor femur dr.Hernowo SAB II/TC
213 414784 Nn.Yana Nur 21th √ Umum FAM S Excisi FAM S dr.Hernowo Masker II/TC
214 413932 Ny.Nur Mufidah 37th √ Umum Tumor sub mandibula Excisi Tumor sub mandibula dr.Hernowo Intubasi III/TC
215 414921 Tn.Chandra Juliar 29th √ Ortho Cl fr clavicula 1/3 tengah Oruf plating Cl fr clavicula 1/3 tengah dr.Danang Intubasi II/TC
216 413702 Ny.Rusdiana S 46th √ Ortho Tensovaginitis Release tendon Tensovaginitis dr.Danang Masker III/TC
217 373835 An.Luthfi Akmal 21th √ Urologi Hidrocele Hidrocelectomy Hidrocele dr.Kristianto Masker III
218 342178 Ny.Prihatini 41th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB VVIPA
G2P1A0+BSC+Ket
219 371501 Ny.Laura Nalurita 34th √ Obgyn G2P1A0+BSC LSCS mekoneal dr.Umi SAB II/VK
220 409266 Ny.Susanti 35th √ Obgyn G3P2A0+PPM LSCS+MOW G3P2A0+PPM dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
221 412790 Ny.Sundari 32th √ Umum 19/10/2017 Tumor punggung Excisi Tumor punggung dr.Bambang TIVA II/TC
222 415086 Tn.Sholeman 38th √ Umum Tumor kepala Excisi Tumor kepala dr.Bambang TIVA III/TC
223 389879 Tn.Rochim 52th √ Umum HIL residif Herniotomy HIL residif dr.Bambang SAB II/TC
Tringger finger digiti III Tringger finger digiti III
224 402121 Ny.Sunariyah 48th √ Ortho manus D
Release tendon hand manus D dr.Danang Masker II/TC
225 180914 Ny.Siska Diah 33th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
226 365587 Ny.Atiek I 32th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
227 415141 Tn.Yahya 51th √ Umum 20/10/2017 Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno TIVA II/TC
228 415224 Tn.M.Shoumu 58th √ Umum Abses scrotalis Incisi Abses scrotalis dr.Sukarno SAB II/TC
229 414842 Ny.Eka Nur C 32th √ Obgyn G2P1A0+PPM LSCS G2P1A0+PPM dr.Umi SAB II/VK
Torsi cista ovarium
230 335831 Ny.Resdiana 35th √ Obgyn Cistoma ovarium SOD+Appendictomy D+Appeniditis dr.Umi SAB II/VK
231 412941 Tn.Yahya Sholi 47th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
232 192854 Ny.Nur fadilah 29th √ Obgyn G3P1A1+letsu LSCS G3P1A1+letsu dr.Umi SAB III/VK
233 415048 Tn Miskan 61th √ Umum 21/10/2017 CKD Psng doublelumen CKD dr.Ary F LA RJ
234 396927 Ny.Nila Asmala 2th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB III/VK
235 203611 Tn.Yusuf perdana 39th √ Ortho Cl fr cruris post plating Aff plate Cl fr cruris post plating dr.Hary C SAB II/TC
236 415364 Tn.Bambang U 41th √ Urologi Batu uretra steno Meatotomy exhadce batu Batu uretra steno dr.Kristianto LA RJ
237 260867 Ny.Lina Kusuma 21th √ Obgyn G1P0A0+KIFL LSCS G1P0A0+KIFL dr.Kery SAB III/VK
238 415041 Ny.Nurul Churnia 32th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
239 218113 Ny.Binti Robingatun 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
240 176144 Ny.Nur Ulumah 33th √ Obgyn 22/10/2017 G1P0A0+PPT LSCS G1P0A0+PPT dr.Kery SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
241 414790 Ny.Dina Mariana 35th √ Obgyn 23/10/2017 G3P1A0+PEB LSCS G3P1A0+PEB dr.Kery SAB II/VK
242 414421 Ny.Vivi Dia Oarina 30th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Haris SAB III/VK
243 414887 Ny.Eni Ningsih 35th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
244 210532 Ny.Sri Munika 53th √ Umum Ganglion poplitea Excisi Ganglion poplitea dr.Hernowo SAB II/TC
245 287558 Tn.Soedibyo 67th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I/TC
246 299699 Ny.Setia Krisyanti 50th √ Umum Basalioma pipi Excisi Basalioma pipi dr.Hernowo TIVA II
247 415083 Tn.Moch Yasik 54th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III/TC
Union fr radius ulna post Union fr radius ulna post
248 1924 An. M.Haikal H 11th √ Ortho plating Aff plate plating dr.Danang Masker PAV
249 414616 NY.Oktriya P 33th √ Obgyn G2P1A0+Lilitan talpus LSCS+Insersi IUD G2P1A0+Lilitan talpus dr.Umi SAB II/VK
250 360393 Ny. Ratih Suryani 36th √ Obgyn G3P2A0_BSC LSCS+MOW G3P2A0_BSC dr.Umi SAB II/VK
251 412011 Ny. Riya Restia 25th √ Obgyn G2P0A0+Post KET LSCS G2P0A0+Post KET dr.Umi SAB III/VK
252 415541 Ny.Bella l 22th √ Obgyn 24/10/2017 G1P0A0+PEB LSCS G1P0A0+PEB dr.Heru B SAB II/VK
253 196763 iNy.Dwi Yuliati 27th √ Obgyn G1P0A0+Haemoroid LSCS G1P0A0+Haemoroid dr.Kery SAB III/VK
254 351975 Ny.Sti Ro'adah 43th √ Umum Lipoma gluteus Exterpasi Lipoma gluteus dr.Sukarno SAB I
255 412696 Ny.Fitri andriani 25th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Kery SAB II/VK
256 280142 Ny.Windartik 32th √ Umum FAM Exterpasi FAM dr.Sukarno Masker II
257 415483 Ny. Ayu Eka 24th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
258 414204 Ny. Sri Daryanti 47th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
259 303898 NY.Afif Rutiyah 37th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB III/VK
260 414987 An.M. Raichan 5bln √ Umum Phymosis Circumsisi Phymosis dr.Bambang Masker II
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI √
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
261 415451 Ny.Noni Anggroli 28th √ Obgyn 24/10/2017 Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB III/VK
262 401962 Ny.Sri Wahyu 35th √ Obgyn G4P2A1+BSC LSCS G4P2A1+BSC dr.Umi SAB II/VK
263 368585 Ny.Alfi Laili R 28th √ Obgyn G1P0A0+High miopi LSCS G1P0A0+High miopi dr.Umi SAB III/VK
264 225564 Ny.Ririn Budiarsih 35th √ Obgyn G2P0A1+CPD LSCS G2P0A1+CPD dr.Umi SAB I/VK
265 322193 Ny.Nita Ika Novi 20th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB III/VK
266 000160 Ny.Lilik Fauziah 44th √ Obgyn Erotio portio Couter Erotio portio dr.Kery SAB II/VK
267 373640 Ny.Dyah Ika R 31th √ Obgyn Cistoma ovarii Wedge resection ov D+S Cistoma ovarii dr.Kery SAB I/VK
268 222080 Tn.Ainur rochim 52th √ Urologi BPH TUR Prostat BPH dr.Kristianto SAB III
269 415505 Ny.Fenny Bina W 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
270 414917 An.Daffa Ahmad 5th √ THT Osase adenotosilitis cronis Adenotonsilectomy Adenotonsilitis dr.Noer S Intubasi VVIPA
271 413729 Ny.Dian Pratiwi 25th √ Obgyn 25/10/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
272 414793 Ny.Andi Erna 50th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
273 413884 Ny.Indah R 33th √ Obgyn HPP Post partum Curetage HPP Post partum dr.Kery SAB II/VK

274 414822 Ny.Yusnia P 27th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Haris SAB III/VK
275 415630 Ny.Yayuk Wijaya 46th √ Obgyn Cistoma ovarii Cistectomy S+D Cistoma ovarii dr.Kery SAB II/VK
276 411117 Ny.Yulianis 25th √ Obgyn G2P1A0+Cistoma ov LSCS+SOD G2P1A0+Cistoma ov dr.Haris SAB II/VK
277 415634 Ny.Indrawati 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB III/VK
278 413188 Ny.Sukiati 57th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
279 409208 Ny.Siti Maryam 2th √ Umum Mamae abrant Excisi Mamae abrant dr.Bambang Masker III/TC
280 231659 Nn.Ade Rahmawati 19th √ Umum FAM Excisi FAM dr.Bambang TIVA I/TC

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
281 271798 Ny.Yuli Nifa 58th √ Umum 25/10/2017 HIL Herniotomy HIL dr.Bambang SAB I/TC
282 413640 Ny.Siti Rohillah 40th √ Umum Ca mamae MRM Ca mamae dr.Hernowo Intubasi I/TC
283 404968 Tn.Tri Rahardjo 49th √ Umum HIL Herniotomy HIL dr.Hernowo SAB III/TC
284 414514 Ny.Hartini 50th √ Umum Ca mamae MRM Ca mamae dr.Hernowo Intubasi II
285 225791 Ny.Dewi Anggra 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
286 411158 Ny.Arlia Harina 33th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
287 415730 Tn.Soedjono 34th √ Ortho Of fr digiti V manus D Pining+debridement Of fr digiti V manus D dr.Hary C Masker II/TC
288 415739 Ny.Dewi Wijaya 23th √ Obgyn 26/10/2017 G1P0A0+Gemelli LSCS G1P0A0+Gemelli dr.Kery SAB II/VK
289 414214 Ny.Santi Nurfita 32th √ Obgyn G4P1A2+BSC LSCS G4P1A2+BSC dr.Umi SAB I/VK
290 223555 Ny.Susanti 36th √ Obgyn G4P2A1+BSC LSCS+SVH G4P2A1+BSC+Plac acreta dr.Umi SAB I/VK
291 414338 Nn.Ida Ayu Putu 43th √ Obgyn Mioma uteri SVH Multiple mioma uteri dr.Umi SAB I/VK
292 415696 An.Colista Azalia 13th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB III
293 415569 Tn.Dari Rejo 65th √ Umum Abses pedis Incisis+debridement Abses pedis dr.Hernowo SAB II/TC
294 415741 Tn.Masruchin 41th √ Ortho Cl fr radius distal D Reposisi+psg gips Cl fr radius distal D dr.Danang TIVA III/TC
295 411314 Ny.Nuraini 61th √ Ortho Carpal turned syndrom Release tendon hand Carpal turned syndrom dr.Danang Masker II/TC
296 405834 Ny.Msluchatin N 29th √ Umum 27/10/2017 FAM Exterpasi FAM dr.Sukarno Masker II/TC
297 268126 Tn.Suwokao E 37th √ Umum Fistula ani Fistulectomy Fistula ani dr.Sukarno SAB II/TC
298 198574 Ny.Shinta Winda 33th √ Obgyn Cistoma ovarii SOS Torsio cistoma ovarii S dr.Kery SAB III/VK
299 398734 Ny.Barokah Rina 29th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB II/VK
300 412430 Ny.Gadis Suci D 33th √ Obgyn G1P0A0+Ologohidramnion LSCS G1P0A0+Ologohidramnion dr.Umi SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
301 415820 Tn.Rizaldi M 28th √ Umum 27/10/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB II
302 415403 Tn.Franses 39th √ Anestesi CKD Psg double lumen CKD dr.Ary F LA III
303 415701 Sdr.Wisnu Sutrisno 23th √ Umum Tumor frontal Excisi Tumor frontal dr.Bambang TIVA II
304 415662 Tn.Ahmad Sarjito 40th √ Umum Tumor frontal Excisi Tumor frontal dr.Bambang TIVA II

305 224751 Ny/Luluk 29th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Umi SAB II/VK
306 207217 Ny.Herni Nunung 47th √ Umum Ca mamae MRM Ca mamae dr.Bambang Intubasi II/TC

307 415899 Ny.Arika Damay 24th √ Obgyn 28/10/2017 Kehamilan ektopik Laparatomy Kehamilan ektopik dr.Kery SAB II/VK
308 412556 Tn.Edy Poernomo 62th √ Urologi Adeno ca prostat Sub capsuler orchidectomy Adeno ca prostat dr.Kristianto SAB I/TC
309 415959 Ny.Erni Pratini 36th √ Obgyn KET SOS KET dr.Kery SAB III/VK
310 389250 Tn.Wahyudi 38th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB I
311 412219 Ny.Giyatni 37th √ Umum Ganglion wrist Excisi Ganglion wrist dr.Hernowo Masker II
312 304298 Ny.Ina Rosita 44th √ Umum Ulkus pedis+DM Nekrotomy+debridement Ulkus pedis+DM dr.Hernowo SAB VVIPA
313 415842 Ny.Endang Kus 48th √ Obgyn Bartholin ciste Exterpasi Bartholin ciste dr.Umi SAB II/VK
314 415789 Ny.Nurul Fiazah 26th √ Obgyn G2P0A1+Letsu LSCS G2P0A1+Letsu dr.Umi SAB II/VK
G1P0A0+CPD+Ket
315 415989 Ny.Dwi Kurnia 23th √ Obgyn 29/10/2014 G1P0A0+CPD LSCS mekoneal dr.Umi SAB II/VK
316 407776 Ny.Ina Dinawati 37th √ Obgyn G6P4A1+PROM LSCS G6P4A1+PROM dr.Umi SAB II/VK
317 376184 Ny.dr.Muzdhalifa 37th √ Obgyn 30/10/2017 G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
318 415895 Sdr.Mujiono 47th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
319 401969 Tn.Munadi 62th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
320 415560 Tn.M.Santoso 37th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
321 315631 Ny.Novi Ilustanti 40th √ Umum 30/10/2017 Ganglion carpi Excisi Ganglion carpi dr.Hernowo Masker III
322 414329 Ny.Solichah 52th √ Umum Tumor mamae Excisi Tumor mamae dr.Hernowo Masker III
323 415941 Nn.Nur Izza Elisa 17th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Hernowo Masker III
324 386305 An.Hafiz 1th √ Umum HIL Herniotomy HIL dr.Hernowo Masker II
325 253440 Ny.Ika Suseno 17th √ Obgyn G4P2A1+BSC LSCS+MOW G4P2A1+BSC dr.Kery SAB II/VK
326 352012 Ny.Vidya Septia 27th √ Obgyn G2P1A0+PROM LSCS+Insersi IUD G2P1A0+PROM dr.Umi SAB II/VK
327 353415 Ny.Siti Mutmaina 30th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
328 412913 Ny.Siti Mujawaro 28th √ Obgyn G3P1A1+BSC+PPM LSCS G3P1A1+BSC+PPM dr.Umi SAB I/VK
Oovarectomy partial
329 218559 Ny.Ummu Failah 40th √ Obgyn Cistoma ovarii bilateral Cistoma ovarii dr.Umi SAB II/VK
330 269936 Ny.Mufidah 29th √ Obgyn 31/10/2017 G3P1A0+BSC LSCS G3P1A0+BSC dr.Kery SAB II/VK
331 307080 Ny.Siti Masfufah 32th √ Obgyn G3P2A0+PP LSCS+MOW G3P2A0+PP dr.Kery SAB II/VK
332 299218 Ny.Ike Lestari 29th √ Obgyn G3P1A0+BSC LSCS G3P1A0+BSC dr.Kery SAB II/VK
333 182144 Tn.Darmaksan 49th √ Obgyn Appendicitis perforasi Lap appendictomy Appendicitis perforasi dr.Sukarno SAB VVIPB

334 233523 An.Emira Cahya 9th √ Umum Hemangioma kepala Exterpasi Hemangioma kepala dr.Sukarno TIVA I/TC
335 402877 Ny.Dian Mayasari 37th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
336 415142 Ny.Umiyanti 55th √ Obgyn Abses dinding vagina Incisi+exterpasi Abses dinding vagina dr.Kery SAB II/VK
337 416151 Ny.Sulastri 38th √ Obgyn G4P2A1+PEB LSCS+MOW G4P2A1+PEB dr.Haris SAB II/VK
338 416141 Ny.Vivin Awita 25th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Haris SAB I/VK
339 416187 Ny.Umi Chamda 32th √ Obgyn G6P3A2+BSC LSCS+MOW G6P3A2+BSC dr.Kery SAB I/VK
340 415870 Ny.Mudaifah 56th √ Umum FAM Excisi FAM dr.Bambang Masker II/TC

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN OKTOBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
L P KH B S K HESI
341 415453 Tn.Agus Heri 61th √ Urologi 31/10/2017 BPH Batu buli buli TUR P+Vesicolitotripsy BPH Batu buli buli dr.Kristianto SAB VVIPA

342 416053 Tn.A.Afandi 38th √ Umum Appendicits akut Appendictomy Appendicits akut dr.Bambang SAB VVIPA

343 416117 Tn.Isrudik 36th √ Ortho Cl fr radius Orif plating Cl fr radius dr.HarI C Intubasi III/TC
Septum deviasi+konka Septum deviasi+konka
344 415802 Sdr.Cahya Hakim 20th √ THT hipertropi
Septoplasti+turbinoplasti
hipertropi dr.Noer Sofi Intubasi II/TC
G3P3A0+Prolong aktif G3P3A0+Prolong aktif
345 416240 Ny.Rohyati 26th √ Obgyn phase LSCS+MOW phase dr.Kery SAB II/VK
346 416257 Ny.Devi Muji 26th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB II/VK
347
348
349
350
351
352
353
354
355
356
357
358
359
360

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
3/I √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

3/II √ √ √

2/II √ √ √

3/III √ √ √

1/II √ √ √
2/IV √ √ √
2/III √ √ √

4/I √ √ √

1/II √ √ √

1/III √ √ √

1/IV √ √ √
2/IV √ √ √

3/IV √ √ √

2/IV √ √ √

3/V √ √ √

2/V √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

2/II √ √ √

3/II √ √ √

3/III √ √ √

3/IV √ √ √

2/III √ √ √
1/I √ √ √

1/II √ √ AIA
1/III √ √ √

3/IV √ √ √

4/I √ √ √

1/IV √ √ √

2/IV √ √ √

1/V √ √ √

2/V √ √ √

3/V √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
3/V √ √ √

2/III √ √ √

1/I √ √ √

3/III √ √ √

3/IV √ √ √

1/I √ √ √

3/V √ √ √

4/I √ √ √

2/I √ √ AIA
1/III √ √ √

1/IV √ √ √

3/VI √ √ √

3/I √ √ √

3/II √ √ √
2/I √ √ √
2/II √ √ √
1/I √ √ √
2/III √ √ √

2/IV √ √ √
2/V √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/III √ √ √

1/II √ √ √

1/III √ √ √

1/IV √ √ √

2/IV √ √ √

3/III √ √ √

2/IV √ √ √

3/IV √ √ √

4/I √ √ √

3/I √ √ √

1/II √ √ √
1/I √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

2/II √ √ √

4/I √ √ √

1/II √ √ Hanwa life


3/III √ √ √

1/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

2/V √ √ √

3/IV √ √ √
1/I √ √ √

2/I √ √ √

1/II √ √ √

1/II √ √ √

4/I √ √ √

2/I √ √ √

3/I √ √ √

3/II √ √ √

1/III √ √ √

3/I √ √ √

1/I √ √ √

3/II √ √ √

2/I √ √ √

2/II √ √ √

1/I √ √ √

2/II √ √ AIA
3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
RR √ √ √

RR √ √ JCI
4/I √ √ √

2/II √ √ √

3/I √ √ RBH
1/II √ √ √

2/III √ √ √

3/III √ √ √

3/II √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

1/II √ √ √

4/I √ √ √

4/II √ √ √
3/II √ √ √

3/I √ √ √

3/II √ √ √

2/III √ √ √

3/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

1/III √ √ √

3/III √ √ √

2/IV √ √ √

4/I √ √ √

1/I √ √ √

1/II √ √ √
1/III √ √ JAPFA
2/I √ √ √

3/I √ √ √

2/II √ √ √

3/III √ √ √

1/III √ √ √

2/III √ √ √

2/IV √ √ √

3/IV √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ √

2/III √ √ √

1/I √ √ √

3/III √ √ √

2/III √ √ LIPPO
1/IV √ √ √

3/III √ √ √

1/III √ √ √

1/II √ √ √

2/IV √ √ √

3/IV √ √ √

3/V √ √ √

1/IV √ √ √

2/V √ √ √

3/VI √ √ √

1/I √ √ √

3/I √ √ √

RR √ √ √

2/I √ √ √
1/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

2/III √ √ √

4/I √ √ Jasa raharja


4/I √ √ √

1/III √ √ √

4/II √ √ √

1/II √ √ √

1/I √ √ √

2/I √ √ √

4/III √ √ √

3/III √ √ √
3/I √ √ √

4/IV √ √ √

2/IV √ √ √

3/I √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √

2/II √ √ √

1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

2/III √ √ √

1/II √ √ √
3/III √ √ √

1/I √ √ √

2/IV √ √ √

2/V √ √ √

3/III √ √ √

3/IV √ √ √

2/V √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ √

1/I √ √ √

3/II √ √ √

RR √ √ √

2/II √ √ √

1/III √ √ √

3/IV √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
keten
4/I √ √ agake
rjaan
4/II √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √

3/II √ √ √

1/I √ √ √

1/II √ √ √

3/III √ √ JAI
2/III √ √ √

1/II √ √ √

3/IV √ √ √

1/III √ √ √

2/III √ √ JPKM
4/I √ √ √
1/III √ √ √

4/II √ √ √

3/V √ √ √

2/IV √ √ √

3/V √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

2/II √ √ RBH
1/I √ √ √

4/I √ √ √

3/I √ √ √

4/II √ √ √

2/I √ √ √

1/I √ √ √
3/I √ √ √

2/II √ √ √

4/I √ √ √

3/I √ √ √

1/I √ √ √

3/I √ √ √

4/I √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

2/III √ √ √

1/I √ √ √

4/II √ √ √

4/I √ √ √

3/IV √ √ √

2/III √ √ √

3/II √ √ √

3/I √ √ √

2/I √ √ √

4/I √ √ √

1/I √ √ √

1/II √ √ √

2/II √ √ √

3/II √ √ √

2/III √ √ √

4/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/IV √ √ √

2/IV √ √ √

1/II √ √ √

2/IV √ √ √

1/III √ √ √

3/V √ √ √

2/IV √ √ √

3/VI √ √ √

3/IV √ √ √

2/V √ √ √

3/I √ √ √

2/I √ √ √
2/III √ √ √

1/II √ √ √

3/II √ √ √

1/I √ √ √

2/II √ √ √

4/I √ √ √

2/III √ √ √

4/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/II √ √ √

2/III √ √ √

1/III √ √ √

2/IV √ √ √
3/IV √ √ √

2/IV √ √ √

4/I √ √ ketenagakerjaan

3/I √ √ √

2/I √ √ √

3/II √ √ √

2/II √ √ √

1/I √ √ √

1/II √ √ √

2/III √ √ √

3/III √ √ √

1/I √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
2/II √ √ √

RR √ √ √

4/I √ √ √

4/II √ √ √

3/III √ √ √

2/IV √ √ √

2/I √ √ √

2/II √ √ √

3/II √ √ √

1/II √ √ √

1/I √ √ √

1/III √ √ √

2/II √ √ √

3/III √ √ √

2/I √ √ √
2/II √ √ √

3/I √ √ √

1/I √ √ √

4/I √ √ √

1/II √ √ ALLIANZ
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/III √ √ √

2/II √ √ √

2/III √ √ √

3/I √ √ √

2/III √ √ √

2/IV √ √ √
3/III √ √ √

3/IV √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

1/II √ √ √

2/II √ √ √

1/III √ √ √

3/III √ √ √

2/III √ √ √

3/IV √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA
ronde EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/III √ √ CAR
4/I √ √ √

4/II √ √ √

2/V √ √ √

3/V √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
P
1 415801 Tn.Sutomo 26th √ Umum 01/11/20147 Tumor colli Exterpasi Tumor colli dr.Sukarno TIVA II
2 293124 Tn.Priyawan S 45th √ Umum HIL Herniotomy HIL dr.Sukarno SAB I/TC

3 416167 Ny.Pari Kartika 50th √ Umum Bartholine ciste Cistectomy Bartholine ciste dr.Haris SAB I/VK
4 414904 Ny.Mufidah 37th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Haris SAB II/VK
5 149239 Nn.Asfa Dinia 14th √ Umum Atheroma femur Excisi Atheroma femur dr.Hernowo LA RJ
6 413144 Ny/Sri Ratnaati 66th √ Umum CKD AV Shunt CKD dr.Hernowo RJ
7 355064 Ny.Alfina Rahma 28th √ Umum FAM Excisi FAM dr.Hernowo Masker II
8 378974 Sdr.Albiansyah F 21th √ Umum HIL Herniotomy HIL dr.Bambang SAB III
9 311768 Nn.Rizka Adintya 14th √ Umum Tumor colli Excisi Tumor colli dr.Bambang TIVA II/TC
10 402265 Ny.Leny Dwi S 31th √ Umum Appendicitis akut Lap appendictomy appendicitis perforasi dr.Sukarno SAB II
11 416172 Nn.Tasya Ayu 17th √ Ortho COR+Cl fr humerus Orif plating COR+Cl fr humerus dr.Danang Intubasi VVIPB
12 239196 Ny.Tities Prasetyo 32th √ Obgyn 02/11/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
13 391046 Ny.Dewi Rosita S 36th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB VVIPA

14 412574 Ny.Dini Ilmiyati 31th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB II/VK
15 354225 Ny.Sri Wuryandari 39th √ Obgyn Mioma uteri SVH+SOS Mioma uteri+cistoma ovarii dr.Kery SAB II/VK
16 416199 Ny.Sumiatun 48th √ Obgyn Mioma uteri SVH+BSO Mioma uteri dr.Haris SAB III/VK
17 341019 Ny.Lutfiah 45th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
18 416332 An.m.Bhismi T 14th √ Ortho Cl fr radius ulna 1/3 tengah Reposisi Cl fr radius ulna 1/3 tengah dr.Danang TIVA II/TC
Stabilisasi
19 278368 Ny.Li'ati 61th √ Ortho Fr kompresi VL I posterior+laminectomy
Fr kompresi VL I dr.Larona Intubasi II/TC

20 208831 Ny.Lidya Novi 40th √ Umum 03/11/207 Tumor inguinal Exterpasi Tumor inguinal dr.Sukarno Masker II/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 178191 Ny.Tri Wikaningsi 38th √ Anestesi 03/11/2017 CKD Pasang double lumen CKD dr.Ary F LA RJ
Union fr clavicula post Union fr clavicula post
22 248851 Tn.Suparno 58th √ Ortho plating Aff plat plating dr.Danang Intubasi I/TC
23 250363 Ny.Nur Chasanah 40th √ Umum Tumor femur Excisi Tumor femur dr.Hernowo SAB II
24 336532 Ny.Enny Zulhaida 46th √ Umum Tumor punggung Excisi Tumor punggung dr.Hernowo TIVA II/TC
25 328150 Tn.Drs.H.M.Tamyis 57th √ Umum HIL Herniotomy HIL dr.Hernowo SAB I
26 281174 Tn.Amrullah 47th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II/TC
27 287747 Tn.Iwan Junaedi 42th √ Ortho Cl fr metacarpal ii,ii,iv S Orif pining Cl fr metacarpal ii,ii,iv S dr.Danang Intubasi II/TC
28 336936 Ny.Tri Lukitingtias 34th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
29 416067 Ny.Putri Puspita 25th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Umi SAB II/VK
30 285330 Ny.Aminah 42th √ Obgyn 04/11/2017 Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB III
31 416570 Ny.Endang S 26th √ Obgyn G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
32 416531 Tn.Smarudin 42th √ Bdh mulut Plegmon Multiple incisi+drainase Plegmon dr.Henry Masker
Ulkus cruris S sekunder Ulkus cruris S sekunder
33 416560 Ny.Anikmatus S 51th √ Umum infeksi Incisi+debridement infeksi dr.Hernowo SAB III
34 319426 Ny.Frusya Prada 34th √ Obgyn G2P1A0+Varises vagina LSCS+Insesrsi IUD G2P1A0+Varises vagina dr.Umi SAB I/VK
35 284996 Ny.Dewi Wahyu 29th √ Obgyn G2P1A0+BSC LSCS+Insesrsi IUD G2P1A0+BSC dr.Umi SAB I/VK
36 275345 Ny.Siwi Lestari 38th √ Obgyn G6P2A3+BSC LSCS+MOW G6P2A3+BSC dr.Umi SAB II/VK
37 413916 Ny.Evi Wahyuni 34th √ Obgyn G3P2A0+Fetal distress LSCS+MOW G3P2A0+Fetal distress dr.Umi SAB II/VK
G2P1A0+Prolong laten G2P1A0+Prolong laten
38 222431 Ny.Dika Kusuma 34th √ Obgyn phase LSCS phase dr.Umi SAB II/VK
39 393111 Ny.Puput S 22th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Umi SAB II/VK
Op fr supraconduler humeri Op fr supraconduler humeri
40 251344 An.M.Gifari 10th √ Ortho S
Orif pining+debridement
S dr.Danang Intubasi VVIPB
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
JNS
SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 314928 Ny.Ajeng Limanto 27th √ Obgyn 05/11/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

42 317475 Ny.Nisful Laili 39th √ Obgyn 06/11/2017 G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
43 416747 Ny.Sri Astutik 27th √ Obgyn G1P0A0+BSC LSCS G1P0A0+BSC dr.Kery SAB II/VK
44 237006 Ny.Nur Mazidah 27th √ Obgyn Abortus incomplit Curetage Abortus incomplit dr.Kery SAB II/VK
45 171235 Ny.Elok Latifatul 32th √ Umum FAM Excisi FAM dr.Hernowo Masker II/VK
46 416669 Tn.Fendi Tri M 27th √ Umum Appendicitis perforasi Lap appendictmy Appendicitis perforasi dr.Hernowo SAB II
47 415094 Tn.Davits Tjatur 48th √ Urologi Varicocle Vasoligasi tinggi palomo Varicocle dr.Kristianto SAB II/TC
Op fr phalang distal digiti III Op fr phalang distal digiti III
48 416796 Sdr.Ary Sumarsono 35th √ Ortho manus S
Orif pining+debridement
manus S dr.Danang LA II/TC
49 312893 Ny.Mike Diantini 31th √ Urologi Strictur uretra Sachse Strictur uretra dr.Kristianto SAB II/TC
50 410663 Ny.Aminatus S 22th √ Obgyn G1P0A0+Gemelli LSCS G1P0A0+Gemelli dr.Umi SAB II/VK
51 409130 Ny.Eli Aprilia 24th √ Obgyn G2P0A1+NST non reaktif LSCS G2P0A1+NST non reaktif dr.Umi SAB II/VK
SVH+SOS+Oovarectomy Multiple mioma
52 235654 Ny.Yeni Aris S 45th √ Obgyn Mioma uteri+cistoma ovarii
partial D uteri+cistoma ovarii dr.Umi SAB II/VK
53 377158 Ny.Miftakhur R 27th √ Obgyn 07/11/2017 G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
54 416853 Ny.Betty Novita 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
55 347306 Ny.Vinny Alfiana 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
56 414186 Ny.Gunarti 35th √ Umum Tumor dinding abdomen Exterpasi Endometriosis dr.Sukarno SAB III/TC
57 416815 Ny.Siti Rahma 33th √ Umum Ganglion carpi Exterpasi Ganglion carpi dr.Sukarno Masker I/TC
58 416765 Nn.Kiky Rizki A 21th √ Umum FAM Multiple Exterpasi FAM Multiple dr.Sukarno Masker III/TC
59 416847 An.Safana 13th √ Umum Abses axilla S Incisi+debridement Abses axilla S dr.Hernowo TIVA I/TC
60 398299 An.Aisya Jafna 1th √ Umum HIL Herniotomy HIL dr.Hernowo Masker II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 415254 Tn.Kusnan 64th √ Urologi 07/11/2017 Tumor testis Inguinal orchidectomy Tumor testis dr.Kristianto SAB III
62 381716 An.M.Bintang 2th √ Umum Meningitis BP gagal infus Vena sectie Meningitis BP gagal infus dr.Hernowo LA II
63 412265 Ny.Fillaili M 28th √ Obgyn 08/11/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
64 287762 Ny.Ely Mu'rifah 31th √ Umum G2P1A0+PP LSCS G2P1A0+PP dr.Kery SAB I/VK

65 244483 Ny.Indah Sari 42th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB VVIPB
66 218264 Ny.Novy Dwi F 35th √ Obgyn G3P1A0+PP LSCS G3P1A0+PP dr.Kery SAB III/VK
67 364610 Ny.Dinda Nursela 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
68 416897 Tn.A.Paudji 48th √ Umum Lipoma punggung Exterpasi Lipoma punggung dr.Sukarno SAB II/TC
69 313008 An.Alzam Hafiy P 47th √ Umum HIL Herniotomy HIL dr.Sukarno Masker II/TC
70 416762 Ny.Indah Wahyu 32th √ Umum Ganglion pedis Exterpasi Ganglion pedis dr.Sukarno SAB II/TC
71 416792 Ny.Yusmanida 58th √ Anestesi CKD Pasang double lumen CKD dr.Ary F LA RJ
72 413144 Ny.Sri Ratnawati 66th √ Anestesi CKD Pasang double lumen CKD dr.Ary F LA RJ
73 256809 Ny.Arik Supriatin 36th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Hernowo Intubasi II
74 416840 An.M.Rafa Al F 1th √ Umum HIL Herniotomy HIL dr.Hernowo Masker I/TC
75 416955 Ny.Tri Astanti 26th √ Umum Appendicitis akut Lap appendictomy Appendicitis akut dr.Sukarno SAB III
76 155182 Ny.Ariyati 51th √ Umum Appendicitis akut Lap appendictomy Appendicitis akut dr.Sukarno SAB III
77 277028 Tn.Dede Moch S 57th √ Umum Abses cruris+DM Incisi multiple Abses cruris+DM dr.Hernowo SAB VVIPA
78 345608 Tn.Abi Haris A 42th √ Umum Tumor temporalis Excisi Tumor temporalis dr.Bambang Masker II/TC
79 380002 Tn.Eko Joko S 51th √ Umum Tumor pipi Excisi Tumor pipi dr.Bambang Masker I/TC
80 416521 Nn.Septi Istafiani 18th √ Umum HIL Herniotomy HIL dr.Bambang SAB II/TC
KETERANGAN :
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 405073 Tn.Riyanto Wibowo 52th √ Ortho 08/11/2017 Cl fr clavicula Orif plating Cl fr clavicula dr.Hari C Intubasi VVIPA
82 413472 Ny.Ernawati 39th √ Obgyn G2P1A0+PP+Letsu LSCS G2P1A0+PP+Letsu dr.Umi SAB II/VK
83 307223 Ny.Alwikatul F 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
84 412044 Tn.Sunarwan 38th √ Urologi Varicocle Vasoligasi tinngi palomo Varicocle dr.Kristianto SAB II/TC
85 416439 Ny.Vitriyah 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
86 335723 Ny.Laras Yunita 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
87 193103 Ny.Muryani 51th √ Ortho 09/11/2017 Op fr ankle orif pining+debridement Op fr ankle dr.Hari C SAB VVIPB
88 244455 Tn.Indra Purba L 32th √ Ortho Op fr metacarpal digiti IV Orif pining Op fr metacarpal digiti IV dr.Hari C Masker II/TC
89 274785 Ny.Ikhsiriyah Aini 31th √ Obgyn G4P3A0+PEB LSCS+MOW G4P3A0+PEB dr.Kery SAB II/VK
90 416468 Ny.Yunita 28th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB III/VK

91 415355 Ny.Heni Hariyati 45th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
92 417029 An.Aly thoriq 10th √ umum Apendicitis acut Apendiktomy perforasi APP dr.Hernowo SAB III
93 343255 Ny Anita riska 39th √ obgyn G3P1-A1 + BSC LSCS G3P1-A1 + BSC dr.Umi SAB II/VK
94 398796 Tn.Jodi dwi h √ umum Papiloma multipel Exterpasi Papiloma multipel dr.Sukarno LA RJ
95 416390 Ny.Luwita putri 23th √ obgyn G2P1-1AO+BSC LSCS G2P1-1AO+BSC dr.Umi SAB II/VK
96 413711 Ny. Sri handayani 47th √ obgyn Cystoma ovarii Cystektomy TOA dr.Umi SAB II/VK
97 412636 Ny. Desi wulandari 27th √ obgyn G3P1-A1 + BSC LSCS +IUD G3P1-A1 + BSC dr.Umi SAB I/VK
98 409523 Ny. Siti khotimah 35th √ obgyn Papiloma multipel Couterysasi Papiloma multipel dr.Umi SAB II/VK
99 417083 An Raisya Rarasati 8th √ THT G2P1-1AO+BSC Excisi G2P1-1AO+BSC dr.Noer Shofi Masker VVIP
100 350611 Ny.Lenika dwi 22th √ THT Septum devisiasi Septoplasty Septum devisiasi dr.Noer Shofi Intubasi II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
101 299061 An Bryan mikaila 4th √ THT 09/11/2017 Corpus alineum Explorasi Corpus alineum dr.Noer Shofi masker II

102 334911 Ny.Ika wulansari 27th √ obgyn Dead conseptus Curetage Dead conseptus dr.Umi SAB I/VK
103 417137 Ny.Tririsa putri 26th √ obgyn GIPO-AO+PROM LSCS GIPO-AO+PROM dr.Umi SAB I/VK
104 334911 Ny.Ika wulandari 27th √ obgyn 10/11/2017 Abortus incompleitus Curetage Abortus incompleitus dr.Kery SAB III/VK
105 417092 Ny.Ponisri 53th √ umum Tumor Kepala Explorasi Ateroma kepala dr.Sukarno Tiva III
106 416989 Nn.Hanum siti hardiyanti 21th √ umum Fam S Excisi Fam S dr.Bambang Tiva III
107 214941 Ny. Ponawati 52th √ umum Ganglion poplitea Excisi Ganglion poplitea dr.Bambang SAB I
108 378306 Tn. Suherman 42th √ umum Ulkus pedis + DM Incisi +Debridement Ulkus pedis + DM dr.Hernowo SAB II
109 417163 Ny.Khusnul urifah 47th √ umum App acut Apendictomy App acut dr.Sukarno SAB III
110 417104 An.Vheryl adventa 11th √ umum App perforasi Laparatomy App perforasi dr.Sukarno SAB III
111 186155 Ny.Onny lestari 30th √ obgyn G3P2-2AO +BSC LSCS G3P2-2AO +BSC dr.Umi SAB III/VK
112 410391 Ny.Ani Astuti 40th √ obgyn 11/11/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
113 417213 Ny.Revidian permana 29th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Kery SAB II/VK
114 234491 Ny.Wiwit nurhidayati 26th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB I/VK
115 213430 Ny,Vera febrika 37th √ obgyn Blight ovum Curetage Blight ovum dr.Umi TIVA I/VK
116 286050 Ny.Imrotul mufidah 25th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr Heru B SAB II/VK

117 416060 Ny.Dian apritaw 30th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
118 413715 Ny.Rika sriwahyuni 33th √ obgyn G2P0A1+plas. Previa LSCS G2P0A1+plas. Previa dr.Umi SAB II/VK
119 417313 Ny.Nurul chotimah 32th √ obgyn 12/11/2017 G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB II/VK
120 417158 Ny.Santi indartik 31th √ obgyn G2P1-1 + BSC LSCS G2P1-1 + BSC dr.Umi SAB III/VK

B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP G2P1A0+BSC OPERATOR INAP
L P HESI

121 280536 Ny.Nihayatun 33th √ Obgyn 13/11/2017 G5P4A0+Letsu LSCS G5P4A0+Letsu dr.Umi SAB III/VK

122 416949 Tn.M.Wiyono 47th √ Umum Tumor dinding abdomen Excisi Tumor dinding abdomen dr.Sukarno SAB II/TC

123 414920 Ny.Elis Tzaroh 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK

124 411497 Tn.Kasisamin 56th √ Obgyn HIL Herniotomy HIL dr.Sukarno SAB III

125 416079 Tn.Hari Kustiawan 23th √ Umum Lympadermitis colli Exterpasi Lympadermitis colli dr.Sukarno Intubasi III

126 417355 Tn.Abu Khoiri 45th √ Umum HIL Herniotomy HIL dr.Sukarno SAB III

127 402626 Sdr.Haidan M 17th √ Umum Appendicitis perforasi Lap appendictomy Appendicitis perforasi dr.Sukarno SAB I
128 417375 Ny.Evi Wadatul 43th √ Obgyn Menometrorarghia Curetage Menometrorarghia dr.Heru B SAB I/VK

129 417170 An.M.Raffasya A 1th √ Umum Tumor dinding dada Excisi Tumor dinding dada dr.Bambang Masker I

130 386346 An.Khanza Rizkya 1th √ Umum Tumor frontal Excisi Tumor frontal dr.Bambang Masker I

131 417381 Ny.Rosidah M 28th √ Obgyn G2P1A0+NST non reaktif LSCS G2P1A0+NST non reaktif dr.Kery SAB III/VK
Tingger fingger digiti III Tingger fingger digiti III
132 227165 Ny.Susilowati 49th √ Ortho manus D Release tendon manus D dr.Danang Masker I/TC

133 270641 Ny.Hanik Farida 31th √ Umum Ca mamae residif Excisi Ca mamae residif dr.Bambang Masker I/TC

134 254322 Ny.Rani Megasari 32th √ Obgyn G1P0A0+PPM LSCS+Insersi IUD G1P0A0+PPM dr.Umi SAB III/VK

135 415312 Ny.Mukhoyyaratul 26th √ Obgyn G1P0A0+CPD LSCS G1P0A0+CPD dr.Umi SAB III/VK

136 414882 Ny.Kurnia Rahma 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
√ G2P1A0+CPD+Ket
137 417438 Ny.Nurin Etika S 28th Obgyn G2P1A0+CPD LSCS mekoneal dr.Umi SAB II/VK
G4P2A1+PEB+letsu+ket
138 416774 Ny.Yayuk Lutfia 36th √ Obgyn G4P2A1+PEB+Letsu LSCS mekoneal dr.Umi SAB II/VK

139 416774 Ny.Eny Wahyu R 51th √ Umum 14/11/2017 Gangliom carpi Exterpasi Gangliom carpi dr.Sukarno Masker II

140 415518 Ny.Lina Oktavia 22th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB II/VK

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
141 408297 Tn.Budiono 55th √ Umum 14/11/2017 Ganglion carpi Exterpasi Ganglion carpi dr.Sukarno TIVA II
142 417458 Tn.Umar Nugroho 72th √ Umum Cista signa clavicula Excisi Cista signa clavicula dr.Sukarno Masker I/TC
143 417270 Ny.Salichatin 35th √ Umum Multiple lipoma Exterpasi Multiple lipoma dr.Sukarno Masker III/TC
144 326256 Ny.Kiki Megawati 26th √ Obgyn 15/11/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
145 382315 Ny.Dini Sulistya 31th √ Obgyn G2P1A0+PRM LSCS G2P1A0+PRM dr.Kery SAB III/VK
146 119881 Ny.Sampun Trami 59th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Sukarno SAB I
147 416921 An.Keisha Erlita 13th √ Umum Fibroma kaki Excisi Fibroma kaki dr.Sukarno SAB I
Partus Partus
148 417356 Ny.Heny Sulistya 32th √ Obgyn imaturus+IUFD+OD+Rest Curetage imaturus+IUFD+OD+Rest dr.Umi SAB II/VK
plasenta+anemi plasenta+anemi
149 301131 Ny.Alia Sofiatun 29th √ Obgyn G3P0A2+APB+PP LSCS G3P0A2+APB+PP dr.Umi SAB II/VK
150 417541 Ny.Siti Erfalinah 24th √ Obgyn G3P2A1+BSC+CPD LSCS G3P2A1+BSC+CPD dr.Kery SAB III/VK
151 315990 Ny.Brigita Sri H 42th √ Obgyn G4P1A2+BSC+IUFD LSCS G4P1A2+BSC+IUFD dr.Kery SAB I/VK
152 414749 Ny.Yuli Restyowati 36th √ Obgyn G4P2A1+Let obliq LSCS G4P2A1+Let obliq dr.Kery SAB II/VK
153 417168 Tn.Suseno 55th √ Umum Tumor pedis Excisi Tumor pedis dr.Bambang SAB II/TC
154 417193 Nn.RR.Daniya F 17th √ Umum Tumor pedis Excisi Tumor pedis dr.Bambang SAB III/TC
155 000491 Ny.Ika Katalina 34th √ Ortho Cl fr clavicula Orif plating Cl fr clavicula dr.Danang Intubasi I/TC
156 417585 Nn.Nuril Amirotus 22th √ Obgyn Cistoma ovarii SOD Cistoma ovarii dr.Kery SAB III/VK
157 405012 Ny.Fikriyatul U 27th √ Ortho Cl fr metacarpal II,III,IV S Orif pining Cl fr metacarpal II,III,IV S dr.Danang Intubasi VVIPB
158 417109 Ny.Irina Ahmada 25th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Umi SAB II/VK
159 400169 Ny.Alfiah 24th √ Obgyn G2P1A0+NST non reaktif LSCS G2P1A0+NST non reaktif dr.Umi SAB II/VK
160 417519 Tn.Dwi Adi P 23th √ Ortho Cl fr clavicula Orif plating Cl fr clavicula dr.Hari C Intubasi II/TC

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
Op fr phalang distal digiti Op fr phalang distal digiti
161 349427 Sdr.Muldiyanto 23th √ Ortho 15/11/2017 III,IV D Orig pining III,IV D dr.Danang Intubasi I/TC
162 417670 Ny.Nur Rahmi K 39th √ Obgyn 16/11/2017 G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Kery SAB II/VK
163 417661 Ny.Qurnia Wanda 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
164 415588 Ny.Siti Rinbawani 53th √ Anestesi CKD Psg CVC CKD dr.Ary F LA PAV
165 417054 Tn.Moh. Nurhadi 46th √ Ortho Tingger fingger digiti III,IV Release tendon Tingger fingger digiti III,IV dr.Danang Masker II//TC
166 417116 Ny.Yeni Erma 35th √ Obgyn G3P2A0+NST non resktif LSCS G3P2A0+NST non resktif dr.Kery SAB II/VK
167 417684 An.Naysilla Amel 12th √ Umum Appendicitis perforasi Lap appendictomy Appendicitis perforasi dr.Sukarno SAB III
168 416398 Tn.Faisol Azhari 32th √ Umum Tumor manus D Excisi Ganglion carpi dr.Danang Masker I
169 373604 Ny.Sri Ariandani 38th √ Obgyn G3P1A1+Letlin LSCS G3P1A1+Letlin dr.Umi SAB II/VK
√ G2P1A0+BSC+ket
170 400511 Ny.Fivin Dina 32th Obgyn G2P1A0+BSC LSCS mekoneal dr.Umi SAB II/VK
171 417388 Ny.Tri Juwita 29th √ Obgyn G2P1A0+PPM+letsu LSCS G2P1A0+PPM+letsu dr.Umi SAB II/VK
172 411065 Ny.Khoirun Nisa 34th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB I/VK
173 417737 Ny.Santi Faria H 27th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB III/VK
174 414422 Ny.Sherli Novia 33th √ Obgyn 17/11/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
175 358422 Tn.Deni Nur Dwi 45th √ Ortho Mal union fr tibia D Aff plate Mal union fr tibia D dr.Hari C SAB I
176 417246 Ny.Hartatik 41th √ Umum Ganglion poplitea Excisi Ganglion poplitea dr.Bambang SAB II/TC
177 417616 Tn.Sholikan 39th √ Umum HIL Herniotomy HIL dr.Bambang SAB II/TC
178 410579 Ny.Rizki Nur S 24th √ Obgyn 18/11/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB III/VK
179 415048 Tn.Miskun 61th √ Anestesi CKD Psg CVC CKD dr.Ary F LA RJ
180 417842 Ny.Suyanti 48th √ Obgyn G4P2-2+PEB LSCS +MOW G4P2-2+PEB dr.Kery SAB I/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
181 406864 Ny.Rina mayasari 30th √ Obgyn 19/11/2017 G2P0A1+PRM LSCS G2P0A1+PRM dr.Heru B SAB II/VK
182 417888 An.Tasya agus T 13th √ Umum 19/11/2017 Apendicitis acut Apendiktomy Apendicitis acut dr.Yan P SAB III/VK
183 417917 Ny.Maulidiya 26th √ Obgyn G3P1-2 LETSU LSCS G3P1-2LETSU dr.Heru B SAB I
184 000378 Ny.Endah rahmawati 25th √ Obgyn G2P0-0A1 LETSU LSCS G2P0-0A1+LETSU dr.Heru B SAB I
185 410386 Tn.Permadi 53th √ Umum 20/11/2017 Hemoroid grade IV Haemoroidectomy Hemoroid grade IV dr.Yan P SAB II/VK
186 402209 Ny.Dewi rianasari 29th √ Obgyn G2P1-1+KPP LSCS G2P1-1+KPP dr.Haris SAB VVIP
187 417940 Ny.Sulikah 29th √ Obgyn G2P1-1+PTT LSCS G2P1-1+PTT dr.Haris SAB II/VK
188 377042 Ny.Anik Atmawati 31th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Haris SAB III/VK
189 271696 Ny.Amelia Sholiha 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
190 226714 Ny.Arum Lasinta 26th √ Obgyn G2P0A1+High miopi LSCS+Insersi IUD G2P0A1+High miopi dr.Umi SAB I/VK
191 003483 An.Fauzan Fitrah 3th √ Umum Phymosis Circunsisi Phymosis dr.Bambang Masker II/TC
192 418050 Ny.Dina Juwita 32th √ Obgyn G2P1A0+PPOP+BSC LSCS G2P1A0+PPOP+BSC dr.Umi SAB II/VK
193 331937 Ny.Dinda Widjaya 25th √ Obgyn 21/11/2017 G3P1A1+APB LSCS G3P1A1+APB dr.Umi SAB II/VK
194 417207 Ny.Yamani 49th √ Umum Struma uni nodusa Strumectomy Struma uni nodusa dr.Sukarno Intubasi II
195 003761 Ny.Ismawati 25th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Kery SAB II/VK
196 417497 Sdr.M.Samsi 24th √ Umum Tumor kepala Exterpasi Tumor kepala dr.Sukarno TIVA II
197 305719 Ny.Eka Putri F 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
198 409458 Ny.Yuli Ratna 27th √ Obgyn Bartholin ciste Cistectomy Bartholin ciste dr.Kery SAB II/VK
199 359110 An.M.Iqbal M 14th √ Umum Appendicitis akut Lap appendictomy Appendicitis akut dr.Sukarno SAB II/VK
200 417900 Ny.Supartini 46th √ Umum Tumor mamae Excisi Tumor mamae dr.Yan P Masker II

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
201 417823 Tn.Ebid Maulana 33th √ Umum 21/11/2017 HIL Herniotomy+omentectomy HIL dr.Bambang SAB II
202 260823 Tn.Alsa Yulianto 52th √ Urologi BPH+Batu buli buli TUR p+litotripsi BPH+Batu buli buli dr.Kristianto SAB III
203 402379 Ny.Evita Choironi 24th √ Obgyn G1P0A0+Haemoroid LSCS G1P0A0+Haemoroid dr.Umi SAB I/VK
Multiple mioma uteri intra
204 259736 Ny.Supartin 43th √ Obgyn Mioma uteri Miomectomy mural dr.Umi SAB II/VK
205 003451 Tn.Rangga Laksana 29th √ THT Adenoid hipertropi Adenolectomy Adenoid hipertropi dr.Noer Shofi Intubasi PAV
206 236847 Tn.Romadi 47th √ Umum 22/11/2017 HIL Herniotomy HIL dr.Yan P SAB II/TC
207 418070 Ny.Mamik Yusmi 29th √ Obgyn G2P1A0+Post date LSCS G2P1A0+Post date dr.Haris SAB II/VK
208 418085 Ny.Mariya Ulfa 33th √ Obgyn G3P2A0+IUFD LSCS G3P2A0+IUFD dr.Haris SAB II/VK
209 415037 Ny.Aplis Setyo 28th √ Obgyn G3P0A2+CPD LSCS G3P0A2+CPD dr.Haris SAB III/VK
210 418090 Ny.Kartika dwi 42th √ Obgyn G3P2A0+miss abortion Curetage G3P2A0+miss abortion dr.Umi SAB II/VK
211 259684 Ny.Ika rizkiyana 37th √ Obgyn G4P3A0+BSC LSCS G4P3-3AO+BSC dr.Umi SAB II/VK
212 418167 Ny. Maniyah 34th √ umum 23/11/2017 Cholelitiasis Cholicistectomy Cholelitiasis dr.Sukarno SAB III
213 415532 Ny.Wahyu Sri L 32th √ Obgyn G4P2-3A0+BSC LSCS+MOW G4P2-3AO+BSC dr.kery SAB II/VK
214 410159 Ninda kusuma 28th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.kery SAB I/VK
215 234281 Ny.Angelina prasetya 32th √ Obgyn G2P1A1+Prolong LSCS G2P1A1+Prolong dr.Haris SAB II/VK
216 418209 Ny.Pipit juniati 21th √ Obgyn G1P0A0+faetal distres LSCS G1P0A0+faetal distres dr.Haris SAB III/VK
217 418205 Ny, Rohma diana 31th √ Obgyn G1P0A0+ CPD LSCS G1P0A0+ CPD dr.Haris SAB II/VK
218 418267 Ny.Siti kotijah 28th √ Obgyn G1P0A0+KPP LSCS G1P0A0+KPP dr.Haris SAB II/VK

219 418258 Ny,Iis dekawati 32th √ Obgyn G2P1A1+BSC LSCS G2P1A1+BSC dr.Haris SAB II/VK
220 418164 Ny.Nurul lailiyah 27th √ Obgyn G1P0A0+Post date LSCS G1P0A0+Post date dr.Haris SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
221 417855 Tn Suyaato 48th √ umum 23/11/2017 DM +Ganggren Debridement DM +Ganggren dr.Yan P SAB I
222 418203 Ny.Puji lestari 27th √ umum FAM S Excisi FAM S dr.Bambang GA masker II/VK
223 418160 Nn.Siti April 19th √ umum FAM D Excisi FAM D dr.Bambang TIVA III
224 416273 Ny.Misriyah 46th √ umum Apendicitis Apendictomy Apendicitis dr.Bambang SAB II
225 317054 Ny.Lailatul M 36th √ obgyn G3P2-2AO+distres LSCS +MOW G3P2-2AO+distres dr.Umi SAB II/VK
226 417707 Ny.Siti Aminatus 23th √ obgyn G1P0A0+hight myopi LSCS G1P0A0+hight myopi dr.Umi SAB II/VK
227 403478 Ny.Tafiyatus S 31th √ obgyn G2P1-1 +BSC LSCS G2P1-1 +BSC dr.Umi SAB II/VK
228 415450 Ny.Dian Anjaswati 56th √ obgyn Polip serviks Exterpasi Polip serviks dr.Umi SAB II/VK
229 402718 Ny.Maulidah 41th √ obgyn G2P1-1A0+PEB LSCS G2P1-1A0+PEB dr.Umi SAB II/VK
230 418310 Ny.Veby novitasari 38th √ obgyn 24/11/2017 G3P2-2 +PORM LSCS G3P2-2 +PORM dr.Umi SAB II/VK
231 417400 Ny.Rafika puspita 30th √ obgyn G1P0-0+Ploating head LSCS G1P0-0+Ploating head dr.Heru B SAB II/VK
232 361450 Tn Kasiadi 60th √ umum HIL Herniotomy HIL dr.Sukarno SAB II
233 392443 Ny.Lutfa R 38th √ umum Cholelitiasis Cholisistectomy Cholelitiasis dr.Sukarno SAB II
234 197692 Sdr.M.Agus 28th √ umum Haemoroid grde III Hemoroidektomy Haemoroid grde III dr.Sukarno SAB I
235 370965 Ny.Mirip kartikasari 36th √ obgyn G4P1-1A2 +plasenta prev LSCS +IUD G4P1-1A2 +plasenta prev dr.Umi SAB I/VK
236 387683 Ny.Luluk asmuna 37th √ obgyn G4P2-2A1+PEB LSCS +IUD G4P2-2A1+PEB dr.Umi SAB II/VK
237 418391 Ny.Madinatul 28th √ obgyn G2P1-A0+BSC LSCS G2P1-A0+BSC dr.Kery SAB II/VK
238 418339 Ny.Dwi fatmawati 35th √ obgyn G3P2-2 +Post date LSCS G3P2-2 +Post date dr.Kery SAB II/VK
239 401220 Ny.Herwina L 25th √ obgyn G1P0AO+ LSCS G1P0AO+ dr.Umi SAB II/VK
240 351250 Ny.Sugaati 36th √ obgyn G2P1-1 +KPP LSCS +MOW LSCS +MOW dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
241 207113 Ny.Lusiani 34th √ obgyn 25/11/2017 G3P2-2 +BSC 2X LSCS +MOW G3P2-2 +BSC 2X dr.Umi SAB II/VK
242 417574 Tn.Nuewahyudi 42th √ umum Cholilitiasis Cholisistectomy Cholilitiasis dr.Yan P Intubasi II/VK
243 414594 Ny.Dian rosalia 29th √ obgyn G2P1-1A0 +BSC LSCS G2P1-1A0 +BSC dr.Umi SAB II/VK
244 418516 Ny.Muslicha 36th √ obgyn 27/11/207 G4P3A1 +BSC LSCS +MOW G4P3A1 +BSC dr.Kery SAB III/VK
245 297534 Ny.Fitrya 33th √ obgyn G3P2A0 ATH+BSC LSCS +IUD G3P2A0 ATH+BSC dr.Umi SAB II/VK
246 417463 Ny.Magdalena 32th √ obgyn G3P1-1A0ATH+BSC LSCS +IUD G3P1-1A0ATH+BSC dr.Heru B SAB II/VK
247 417645 Ny.Ana shofiana 38th √ obgyn Cystoma ovarii oovarectomy Cystoma ovarii dr.Heru B SAB II/VK
248 418501 Tn.Sumadi 51th umum HIL D =post incarserata Herniatomy HIL D =post incarserata dr.Yan P SAB II/TC
249 417879 Ny.Khuril fauziah 46th umum HIL Herniatomy HIL dr.Yan P SAB I/TC
250 418518 Ny.Rizka Maulidiya 21th √ obgyn G1P0-0 +KPD LSCS G1P0-0 +KPD dr.Haris SAB III/VK
251 418510 Ny.Noftaliyah 27th √ obgyn G2P1-1A0 +BSC LSCS G2P1-1A0 +BSC dr.Haris SAB II/VK
252 418511 Ny.Panca saputri 29th √ obgyn G3P1-1A0ATH+BSC LSCS G3P1-1A0ATH+BSC dr.Haris SAB II/VK
253 418506 Ny.Umul khasanah 27th √ obgyn G2P1-1A0 +BSC LSCS G2P1-1A0 +BSC dr.Haris SAB II/VK
254 316658 Ny.Ulina 51th √ obgyn Cystoma ovarii SOD Cystoma ovarii dr.Haris SAB VVIP
255 418512 Ny.Eka dewi A 28th √ obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
256 417905 Ny.Maya nuri A 37th √ obgyn Cystoma ovarii SOD Cystoma ovarii dr.Umi SAB I/VK
257 418598 Ny.Reni retnonongsih 22th √ obgyn G1P0-0 +KPD LSCS G1P0-0 +KPD dr.Umi SAB II/VK
258 418044 An. M. Maula akbar 3th √ Ortho Dislokasi caput femur Orif pinning Dislokasi caput femur dr.Hari C Intubasi II
Debridement+eksplorasi
259 418600 Sdr.M.Rafli H 19th √ Ortho Cross injuri dgt.II/III tendon Cross injuri dgt.II/III dr.Danang Intubasi II
260 417117 Ny.Sarti 38th √ obgyn G3P2-A0+Plasenta pre LSCS +MOW G3P2-A0+Plasenta pre dr.Umi SAB III/VK
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI √
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
261 418502 Ny.Dewi Sihariya 34th √ Obgyn 27/11/2017 Abortus incomplit Curetage Curetage dr.Haris SAB II/VK
262 343042 Ny.wiwien Tresna 42th √ Obgyn Abortus incomplit Curetage Curetage dr.Haris SAB II/VK
263 369242 Ny.Ngatmini 47th √ Umum Appendicitis akut Appendictomy Appendictomy dr.Hernowo SAB II
264 418424 Ny.Siti Rodiyah 32th √ Obgyn 28/11/207 G1P0A0+letsu LSCS LSCS dr.Kery SAB II/VK
265 417985 Ny.Ina Nurrohmi 34th √ Obgyn G3P2A0+BSC LSCS+MOW LSCS+MOW dr.Kery SAB II/VK
266 289790 Ny.Santi Tribawa 39th √ Obgyn G4P2A1+BSC LSCS+MOW LSCS+MOW dr.Kery SAB I/VK
267 418224 Ny.Erna Palupi 40th √ Obgyn G3P2A0+BSC LSCS+MOW LSCS+MOW dr.Umi SAB I/VK
268 278966 Ny.Ika Putri P 27th √ Obgyn Mioma uteri SOS Cistoma ovarii dr.Kery SAB II/VK
269 213957 Ny.Ika Andhiny 33th √ Obgyn G2P1A0+cistoma ovarii LSCS+SOD LSCS+SOD dr.Kery SAB II/VK
270 212474 Tn.Edy Sutrisno 62th √ Umum HIL Herniotomy Herniotomy dr.Sukarno SAB II/TC
271 413386 Ny.Suharnanik 60th √ Umum Giant lipoma femur Exterpasi Exterpasi dr.Sukarno SAB II/TC
272 374210 Ny.Yustin Andria 29th √ Umum FAM duplex Excisi Excisi dr.Hernowo Masker VVIPA
273 302523 Ny.Farida Rusdia 38th √ Umum Tumor parotis Excisi Excisi dr.Yan P TIVA I/TC
274 417001 Sdr.M.Ilham F 16th √ Umum HIL Herniotomy Herniotomy dr.Hernowo SAB II/TC
275 209822 Tn.Toto Busono 53th √ Umum Abses pedis Multiple incisi+debridement Multiple incisi+debridement dr.Hernowo SAB I
276 367445 Ny.Maria Fransisca 45th √ Obgyn Mioma uteri SVH+SOS Mioma uteri+cistoma ovarii dr.Kery SAB II/VK
277 078399 Ny.Lailatul F 26th √ Obgyn G1P0A0+HbS Ag+ LSCS+SOD G1P0A0+Cistoma ovarii dr.Kery SAB II/VK
278 418333 Tn.Sumadi 64th √ Urologi Batu buli buli Vesicolithotomy Vesicolithotomy dr.Kristianto SAB II/TC
279 112916 Ny.Choirun Nisa 40th √ Obgyn G6P1A4+PROM LSCS+Insersi IUD LSCS+Insersi IUD dr.Umi SAB II/VK
280 329632 Ny.Rifatun Zaqia 29th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD LSCS+Insersi IUD dr.Umi SAB I/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
281 325772 An.Maria Ivana 12th √ Umum 29/11/2017 Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB II/TC
282 418256 Tn.Kadar 67th √ Umum HIL Herniotomy+orchidopecty HIL+Kriptokismus dr.Yan P SAB III/TC
283 402345 Ny.Karina Sanjaya 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
284 418657 Ny.Hasnia 44th √ Umum Haemoroid Excisi Haemoroid dr.Yan P SAB III/TC
285 196045 Ny.Darsih 35th √ Obgyn G7P2A4+BSC LSCS+MOW G7P2A4+BSC dr.Umi SAB II/VK
286 415945 Ny.Siti Mijizah 35th √ Obgyn G4P1A2+BSC LSCS G4P1A2+BSC dr.Umi SAB II/VK
287 418585 Ny.Yulia Afrianti 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
288 414978 Ny.Nunik Intarti 29th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB II/VK
289 327206 Ny.Tri Wiyanti 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
290 354793 Ny.Maria Ulfa 25th √ Obgyn 30/11/2017 G2P0A1+PPM+CPD LSCS G2P0A1+PPM+CPD dr.Umi SAB II/VK
291 418803 Ny.Ani Agustin T 40th √ Obgyn G3P2A0+PROM LSCS+MOW G3P2A0+PROM dr.Umi SAB II/VK
292 418704 An.Qianno Al S 6th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno Intubasi II/TC

293 415403 Tn.Franses 40th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ


294 378306 Tn.Suherman 42th √ Umum Abses pedis +DM Multiple incisi+debridement Abses pedis +DM dr.Hernowo SAB II
295 418765 Tn.Ali Ma'ruf 52th √ Umum Abses gluteus+DM Multiple incisi+debridement Abses gluteus+DM dr.Hernowo SAB III
296 281971 An.James Christello 6th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo Intubasi III
297 181763 An.Raihana Nuril 7th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Sukarno SAB I
298 418575 Tn.M.Yasir 53th √ Umum Peritonitis+streng ileus Lap appendictomy Peritonitis+streng ileus dr.Sukarno SAB II
299 418679 Ny.Fery Nurmira 23th √ Obgyn G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Umi SAB III/VK
300 415697 Ny.Deta Putri H 23th √ Obgyn Blighted ovum Curetage Blighted ovum dr.Umi SAB III/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
Cistoma ovarii coklat
301 415484 Ny.Djumiati 48th √ Obgyn 30/11/2017 Cistoma ovarii SOD+Cistectomy bilateral dr.Umi SAB II/VK
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
L P KH B S K HESI
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
1/I √ √ √

2/I √ √ √

1/II √ √ √

3/I √ √ √

2/II √ √ √

4/I √ √ √

2/III √ √ √

3/II √ √ √
2/IV √ √ √
1/III √ √ √
ADME
4/I √ √ DIKA

3/I √ √ √

2/I √ √ √

3/II √ √ √
2/II √ √ √

3/III √ √ √

2/III √ √ √

1/III √ √ AIA

4/I √ √ √
IN
1/I √ √ HEALTH
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
RR √ v

4/I √ √ v

1/I √ √ v

2/I √ √ v

1/II √ √ v

2/II √ √ v
4/II √ √ v

3/I √ √ v

2/III √ √ v

2/I √ √ v

3/I √ √ v

1/I √ √ v

1/II √ √ v

2/II √ √ v

2/I √ √ v

2/III √ √ v

3/I √ √ v

2/I √ √

3/II √ √

4/I √ √ v
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

2/II √ √ √

1/II √ √ √

3/II √ √ √

4/I √ √ √

2/II √ √ √

3/III √ √ √

2/III √ √ √

3/IV √ √ √

3/I √ √ √

3/II √ √ √
2/I √ √ √
1/I √ √ √
4/I √ √ √
4/II √ √ RBH
1/II √ √ √
2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

1/IV V √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

3/III √ √

1/II √ √ √

1/I √ √ √

2/II √ √ √

3/II √ √ √

RR √ √
RR √ √

2/III √ √ √

2/IV √ √ √

1/IV √ √ √

1/III √ √ √

1/V √ √ √

4/II √ √ √

2/III √ √ √

4/II √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √

3/V √ √ √

3/III √ √ √
2/IV √ √ √

2/V √ √ √

3/IV √ √ √

4/I √ √ √

4/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

1/II √ √ √

2/I √ √ √

4/I √ √

3/II √ √ √

3/III √ √ √

2/III √ √ √

1/V √ √ √

4/II √ √ √

4/III √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/IV √ √ Admedik

1/IV √ √ Adira
3/IV √ √

1/IV √ √ Nestle
2/I √ √ √

2/II √ √ √

3/IV √ √ √

1/II √ √

2/III √ √ √

2/IV √ √ √

3/II √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

4/I √ √ √
3/III √ √ JAI
3/IV √ √ √

2/II √ √ √

2/I √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

4/I √ √ √

3/I √ √ √

2/II √ √ √

3/II √ √ √

3/II √ √ √

2/III √ √ √
4/II √ √ √

1/III √ √ √

1/II √ √ √

3/IV √ √ √

4/II √ √ √

2/III √ √ √

3/III √ √ JAI
2/IV √ √ √

3/IV √ √ √

2/V √ √ √

3/V √ √ √

1/II √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/I √ √ √

2/II √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/II √ √ √

2/II √ √ √

3/III √ √ √

3/IV √ √ √

2/III √ √ √

1/III √ √ √

1/IV √ √ √

4/I √ √ √

2/IV √ √ √

4/II √ √ √

2/IV √ √ √

3/IV √ √ √
4/III √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/IV √ √ √

3/I √ √ √

2/I √ √ √

RR √ √ √

4/I √ √ √

3/II √ √ √

1/I √ √ √

2/II √ √ √

3/III √ √ √

2/I √ √ √

2/IV √ √ √
2/IV √ √

3/IV √ √ √

3/I √ √ √

4/I √ √ √

1/I √ √ √

2/I √ √ √

3/I √ √ √

RR √ √ √

3/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √

1/II √ √ √

3/I √ √ √
2/I √ √ √

1/II √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

3/III √ √ KAI
2/II √ √ √

2/III √ √ √

2/IV √ √ √

3/I √ √ √

4/I √ √ √

3/II √ √ √

4/II √ √ √

2/I √ √ √

1/II √ √ √

2/II √ √ √

4/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

2/III √ √ √

1/IV √ √ √

2/IV √ √ √

2/V √ √ √

1/I √ √ √

3/I √ √ √

1/II √ √ √

2/I √ √ √

1/II √ √ √

2/II √ √ √

2/I √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √
2/II √ √ √

4/II √ √ √

3/III √ √ √

2/III √ √ √

1/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/III √ √ √

2/IIII √ √ √

3/IIII √ √ √

2/IIII √ √ √

3/IIIII √ √ √

2/IIII √ √ √

3/IIIII √ √ √

2/IIII √ √ √
3/IIIII √ √ √

2/I √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

1/II √ √ √

2/II √ √ √

3/II √ √ √

3/I √ √ √

2/I √ √ JAI
2/II √ √ √

3/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

2/III √ √ √

3/II √ √ √

3/II √ √ paket
2/III √ √ √

4/I √ √ √

4/II √ √ √

1/I √ √ √

1/II √ √ √

2/III √ √ √

2/IV √ √ √

3/IV √ √ √

3/III √ √ √

3/IV √ √ √

1/III √ √ √

3/IV √ √ √

3/V √ √ √

4/II √ √ √

2/IV √ √ ketenaga

2/V √ √ √
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/VI √ √ √

2/VI √ √ √

2/V √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

1/I √ √ √

2/II √ √ √

3/III √ √ √

1/II √ √ √

2/III √ √ √

4/I √ √ √
1/II √ √ √

4/II √ √ √

2/IV √ √ √

3/IV √ √ √

1/II √ √ √

3/IV √ √ √

4/III √ √ √

3/IV √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

2/I √ √ √

3/I √ √ √

1/II √ √ RBH
3/II √ √ √

2/II √ √ √

3/III √ √ √

1/II √ √ √

2/III √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

4/I √ √ √

1/IV √ √ √

1/III √ √ √

1/II √ √ √

2/II √ √ √

2/III √ √ √

3/III √ √ √

3/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA
ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
KH B S K PRE OP POST OP HESI
L P
1 156495 An.Anisa Maulidina 8th √ Umum 12/1/2017 Appendicitis akut Lap appendictomy Appendic perforasi dr.Hernowo Intubasi I
Peritonitis appendic
2 215717 Ny.Erna Lukitasari 46th √ Umum Lap appendictomy Appendic perforasi dr.Sukarno SAB I
perforasi
Peritonitis appendic
3 418817 Nn.Lina Novita 28th √ Umum perforasi Lap appendictomy Appendic perforasi dr.Sukarno SAB II
4 416792 Ny.Yisinanindar 58th √ Anestesi CKD Revisi CVC Revisi CVC dr.Ary F LA RJ
5 418910 Ny.Sulastri 27th √ Obgyn G1P0A0+KPP LSCS LSCS dr.Umi SAB II/VK
6 381484 Ny.Lasilmi Kaffah 38th √ Obgyn G4P0A3+Prematur LSCS LSCS dr.Umi SAB II/VK
7 415605 Tn.Samsul huda 49th √ Umum 02/12/2017 Appendicitis cronic Apendictomy Appendicitis cronic dr.Hernowo SAB III/TC
8 181697 Ny.Evita diana 43th √ Umum Appendicitis cronic Apendictomy Appendicitis cronic dr yan SAB I/TC
9 419010 Ny.Desi purnawati 28th √ Obgyn 03/12/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
10 419019 Ny.Dewi suryani 39th √ Obgyn G1P0A0+Featal distres LSCS G1P0A0+Featal distres dr.Umi SAB II/VK
11 400697 Ny.Khulukiyah 26th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Umi SAB III/VK

12 418013 Ny.Atik ul istigomah 35th √ Obgyn G2P2A0+BSC LSCS +MOW G2P2A0+BSC dr.Umi SAB II/VK
13 419008 Tn.dr. Musonnif 29th √ Umum 04/12/2017 Peraianal Abces Incisi abces Peraianal Abces dr.Yan P SAB VVIP

14 418872 Ny.Ria susanti 27th √ Obgyn G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Umi SAB III/VK
15 416976 Ny.Askur niatin 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
16 410236 An.Zanuar robith 9th √ Umum Ganglion antebracii Excisi Ganglion antebracii dr.Hernowo TIVA II/TC
17 316262 Ny.Fransica maria 59th √ Umum Sruma uni nodusa Sub total lobectomy Sruma uni nodusa dr.Hernowo Intubasi I/TC
18 418741 Nn Selia desta 19th √ Umum FAM Duplex Multiple excisi FAM Duplex dr.Bambang Masker II/TC
19 418590 Sdr.Ali Machfud 22th √ Obgyn Union post plating tibia D Aff plate Union post plating tibia D dr.Hari C SAB II

20 417299 Sdr.Rendra fauzi 28th √ ortho Cl.fraktur humeri S Orif plating Cl.fraktur humeri S dr.Hari C Intubasi II
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
21 215313 Ny.Indah ayu 27th √ Obgyn 05/12/2017 KET Salpingectomy KET dr.Umi SAB II/VK
22 419160 Nn.Fitri 18th √ umum FAM D Excisi FAM D dr.Sukarno SAB II/TC
23 355969 Ny.Siti aisyah 52th √ umum Apendicitis acut Apendictomy Appendicitis dr.Sukarno SAB VVIP
SVH Mioma uteri dr.Umi
24 306252 Ny.Faridah cahya 24th √ umum Apendicitis acut Apendictomy Apendicitis acut dr.Hernowo SAB II/TC
25 419225 An.Syifa nur 1th √ ortho Cl. Fr.Femur 1/3 prox S Orif plating Cl. Fr.Femur 1/3 prox S dr.Hari C Intubasi II/TC
26 317288 Ny.Laili fitrotu 33th √ Obgyn G1PO-0 +Post cyste LSCS G1PO-0 +Post cyste dr.Umi SAB I/VK
27 366394 Ny.Yuli astutik 42th √ Obgyn G2P1A0 +BSC LSCS G2P1A0 +BSC dr.Umi SAB II/VK
28 419334 Ny.Rulli nidiana 25th √ Obgyn G1P0A0 +PROM LSCS G1P0A0 +PROM dr.Umi SAB II/VK
29 419338 Ny.Widiyah 22th √ Obgyn G1P0A0 +PROM LSCS G1P0A0 +PROM dr.Umi SAB III/VK
30 419340 Ny.Uhnuhum 21th √ Obgyn 06/12/2017 G1P0A0 +Faetal distres LSCS G1P0A0 +Faetal distres dr.Umi SAB III/VK
31 418082 Ny.Sumarni 47th √ umum Tumor mamae Excisi Tumor mamae dr.Yan P Masker II/TC
32 284546 Tn Suwari 56 th √ umum HIL Duplex Herniotomy HIL Duplex dr.Sukarno SAB III/TC
33 397602 Ny.Ida dwi surya 50th √ √ umum Ganglion poplitae Excisi Ganglion poplitae dr.Hernowo SAB I
34 407898 Ny,Nur rosydah 47th √ umum Struma uni nodusa Subtotal lobectomy Struma uni nodusa dr.Hernowo Intubasi II/TC

35 418842 Ny.Cristiya putri 29th √ Obgyn G1P0A0 +BSC LSCS G1P0A0+BSC dr.Umi SAB II/VK
36 419365 Ny.Aliyah fuad 37th √ Obgyn KET +Appendicitis acut Apendictomy+SOS KET +Appendicitis acut dr.Umi SAB I/VK
37 419368 Ny.Desi kartikasari 38th √ Obgyn G3P2A0+Nst non reaktif LSCS G3P2A0+Nst non reaktif dr.Umi SAB II/VK
38 419411 Ny.Lady mardalea 23th √ Obgyn G1P0A0+Fetal distres LSCS G1P0A0+Fetal distres dr.Umi SAB II/VK
39 003121 Ny.Ninik khoiriyah 39th √ Obgyn G3P2-2AO+PROM LSCS G3P2-2AO+PROM dr.Umi SAB II/VK
40 340440 Ny.Santi wulandari 24th √ Obgyn G1P0A0 +Astma bronkial LSCS G1P0A0 +Astma bronkial dr.Umi SAB II/VK
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017
KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
41 191743 Ny.Kiki Widya 36th √ Obgyn 06/12/2017 G4P2A1+BSC LSCS+Insersi IUD G4P2A1+BSC dr.Umi SAB II/VK
42 414744 Ny.Sri Utami N 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB I/VK
43 419427 Ny.Qurrota A'yun 40th √ Obgyn G3P2A0+Letsu LSCS G3P2A0+Letsu dr.Umi SAB II/VK
44 419172 An.Syafala Rizki 19th √ Umum 07/12/2017 Appendicitis kronis Appendictomy Appendicitis kronis dr.Hernowo SAB III
45 002711 Ny.Rustini 37th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
46 177746 Tn.Japri Jamil 49th √ Umum Abses gluteus Incisi+debridement Abses gluteus dr.Hernowo SAB II
47 270697 Tn.Abd. Nafi 35th √ Urologi Varicocle Vasoligasi tinggi palomo S Varicocle dr.Kristianto SAB II
48 381585 Ny.Rizki Yona A 23th √ Obgyn G1P0A0+NST non reaktif LSCS G1P0A0+NST non reaktif dr.Umi SAB I/VK
49 349624 Ny.Yuliana 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
50 415977 Ny.Novita Rahayu 27th √ Obgyn G3P1A1+BSC LSCS G3P1A1+BSC dr.Umi SAB II/VK
51 328984 Ny.Maftuhatul M 48th √ Umum Tumor lengan atas Excisi Tumor lengan atas dr.Yan P Masker II/TC
52 350165 Tn.Nasikin 43th √ Umum Plagma dasar muka Incisi drainage Plagma dasar muka dr.Yan P TIVA III
53 419259 Tn.Mustofa 41th √ Umum Appendicitis Laparatomy Appendicitis dr.Sukarno SAB II
54 331490 Ny.Siti Kahyuni 43th √ Umum Appendicitis kronik Laparatomy Appendicitis kronik dr.Sukarno SAB II
55 178191 Ny.Tri Wilesningsi 38th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA RJ
56 419482 Ny.Siti Ghoimah 49th √ Umum FAM Excisi FAM dr.Yan P Masker III/TC
57 400055 Ny.Fita Agus S 37th √ Umum FAM Excisi FAM dr.Bambang TIVA II/TC
58 324942 Ny.Margareta Yuli 60th √ Umum Multiple melanoma Multiple excisi Multiple melanoma dr.Bambang TIVA I/TC
59 419336 Ny.Ninik Ratih 22th √ Umum Struma uni nodusa Sub total labectomy Struma uni nodusa dr.Bambang Intubasi I/TC
60 419446 Ny.Astifah 44th √ Umum 09/12/2017 Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB III/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
61 363914 Ny.Aslichatul F 31th √ Obgyn 09/12/2017 G2P1A0+PROM+bayi besar LSCS+Insesrsi IUD G2P1A0+PROM+bayi besar dr.Umi SAB II/VK
62 295092 Ny.Nurul Khalima 23th Ortho Of fr metacarpal II manus D Orif pining+debridement Of fr metacarpal II manus D dr.Hari C Intubasi II/TC
63 419258 Ny.Djumaiyah 60th √ Umum 11/12/2017 HIL Herniotomy HIL dr.Yan P SAB III
64 419779 Ny.Sulistyowati 36th √ Obgyn G1P0A0+HSVB LSCS G1P0A0+HSVB dr.Haris SAB II/VK
Fistulectomy+haemoroidect
65 417790 Nn.Niken Franciska 25th √ Umum Perianal fistel omy
Perianal fistel+haemoroid dr.Yan P SAB II
66 419557 Tn.Surono 46th √ Umum HIL Herniotomy HIL dr.Yan P SAB II
67 011610 Ny.Suhartatik 48th √ Umum Multiple lipoma brachialis Excisi Multiple lipoma brachialis dr.Hernowo Masker II
68 419523 Sdr.A.Yugo 16th √ Umum Multiple clavus pedis Excisi Multiple clavus pedis dr.Hernowo SAB II
69 398333 Tn.Sutoyo 63th √ Umum HIL Herniotomy HIL dr.Bambang SAB II
70 385428 Ny.Siti Khoiriyah 45th √ Umum Tumor punggung Excisi Tumor punggung dr.Bambang SAB II/TC
71 419132 Sdr.M.Ilham S 17th √ Urologi Varicocle Vasoligasi tinngi palomo Varicocle dr.Kristianto SAB I/TC
Union fr clavicula post Union fr clavicula post
72 419563 Tn.Sapawi 53th √ Ortho clavicula Aff plate clavicula dr.Hari C Intubasi I/TC
73 392196 An.Nashwa E 10th √ Ortho Dislokasi sendi S Orif pining+debridement Dislokasi sendi S dr.Hari C Intubasi III
74 412211 Ny.Indrayati 40th √ Obgyn G1P0A0+PPM LSCS G1P0A0+PPM dr.Umi SAB II/VK
75 403546 Ny.Titis Nua R 27th √ Obgyn G2P1A0+NST non reaktif LSCS G2P1A0+NST non reaktif dr.Umi SAB II/VK
Snake bite compromise Snake bite compromise
76 419751 Ny.Ana Fitri S 22th √ Umum 12/12/2017 sindroma Incisi sindroma dr.Sukarno SAB III/TC
77 301174 Ny.Ranny Indria 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB I/VK
78 330934 Ny.Indriyati 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB VVIPA

79 419858 Ny.Choirun Nisa 27th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB II/VK
80 177070 Ny.Medina W 37th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Kery SAB II/VK
KETERANGAN :
: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
81 419643 Ny.Sulis 28th √ Obgyn 12/12/2017 G2P1A0+BSC LSCS G2P1A0+BSC dr.Haris SAB II/VK
82 265855 Ny.Henny Indra 46th √ Ortho Ganglion poplitea Excisi Ganglion poplitea dr.Hari C SAB VVIPA
83 418049 Ny.Rukiyah 49th √ Obgyn Cystoma ovarii torsi Buka tutup Cystoma ovarii torsi dr.Kery SAB II/VK
√ Umum Perlengketan usus Perlengketan tumor diusus dr.Sukarno
84 418442 Ny.Sri Puji H 53th √ Obgyn G2P1A0+BSC LSCS+MOW G2P1A0+BSC dr.Umi SAB III/VK
85 419357 Ny. Nindi Dea V 27th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Umi SAB I/VK
86 413130 Ny.Sulis S 27th √ Obgyn G2P1A0+PP LSCS G2P1A0+PP dr.Umi SAB II/VK
87 416382 Ny.Safitri Putri 36th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB III/VK
88 233755 Ny.Siti Ponimah 36th √ Obgyn G3P2A0 +BSC LSCS G3P2A0 +BSC dr.Umi SAB III/VK
89 419886 Ny.Eni Purwati 40th √ Obgyn G5P4A0 +PEB LSCS G5P4A0 +PEB dr.Umi SAB III/VK
90 419924 Ny.Siti Maryatun 49th √ Umum 13/12/2017 Hemangioma Excisi Hemangioma dr.Sukarno TIVA III

91 419782 Tn.Ahmad Kuzaeni 47th √ Umum HIL D Herniotomy HIL D dr.Sukarno SAB III
92 244589 Ny.Nikmatur 39th √ Obgyn G3P2A0 +BSC LSCS+MOW G3P2A0 +BSC dr.Kery SAB II/VK
93 417615 Ny.Slamatul H 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
94 404719 Ny.Winny Gessy 28th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru B SAB II/VK
95 203141 Ny.Ika Prastian 30th √ Obgyn G3P1A0 +BSC LSCS G3P1A0 +BSC dr.Kery SAB II/VK
96 250435 Ny.Inayatul M 31th √ Obgyn G4P2A0+Blighted ovum Curetage G4P2A0+Blighted ovum dr.Kery SAB II/VK
97 419815 Ny. Nur Hayati 45th √ Umum Aterum punggung Excisi Aterum punggung dr.Sukarno SAB III
98 392508 Ny.Lilik Purwanti 37th √ Obgyn G2P1A0+pp LSCS G2P1A0+pp dr.Kery SAB II/VK
99 419908 Ny.Rifani Puput 29th √ Obgyn G3P1A0+PEB LSCS G3P1A0+PEB dr.Haris SAB II/VK
100 418852 Nn.Vita Dewi 22th √ Umum FAM S Excisi FAM S dr.Haris TIVA III
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
101 418344 Nn.Srianti 26th √ Obgyn 13/12/2017 Cistoma ovarii Wedfe resection bilateral Cistoma ovarii bilateral dr.Haris SAB II/VK

102 419370 Tn.Sujak 51th √ Umum Appendicitis kronik Appendictomy Appendicitis kronik dr.Hernowo SAB III
103 418897 Ny.Eka Agustin S 23th √ Obgyn G1P0A0+Oligohidramnion LSCS+Insersi IUD G1P0A0+Oligohidramnion dr.Umi SAB III/VK
104 416999 Sdr.Eriko Ferdian 16th √ Umum Appendicitis akut Appendictomy Appendicitis akut dr.Hernowo SAB II
Op fr phalanx prox digiti IV,V Op fr phalanx prox digiti IV,V
105 291906 Tn.R.P.Aji S 36th √ Ortho pedis S
Orif pining+debridement
pedis S dr.Danang SAB II
106 252252 Tn.Risvi Iqbal 35th √ Ortho Cl fr elbow Debridement+reposisi gips Cl fr elbow dr.Danang Intubasi III
107 419137 Ny.Astutik √ Obgyn G1P0A0+NST non reaktif LSCS G1P0A0+NST non reaktif dr.Umi SAB II/VK
108 419261 Ny.Nur Faidah 37th √ Obgyn 12/14/2017 G3P1A1+Anchepal LSCS G3P1A1+Anchepal dr.Umi SAB III/VK
109 415788 Ny.Desy Puji P 31th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB II/VK
110 178311 Ny.Yubi Indah R 36th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Kery SAB I/VK
111 375031 Ny.Siti Aisyah 36th √ Obgyn G3P2A0+PP LSCS G3P2A0+PP dr.Kery SAB I/VK
112 396928 Ny.Silviyah 40th √ Obgyn G3P2A1+BSC LSCS+MOW G3P2A1+BSC dr.Kery SAB II/VK
113 418245 Tn.H.Khoiron 62th √ Umum Lipoma maligna Incisional biopsi Lipoma maligna dr.Yan P SAB I/TC
114 420049 Ny.Sri Sulistyo 56th √ Umum HIL Herniotomy HIL dr.Yan P SAB I/TC
115 178191 Ny.Tri Wikaningsi 38th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
116 362393 Ny.Yuliatin 38th √ Obgyn G5P1A3+Letsu LSCS G5P1A3+Letsu dr.Kery SAB II/VK

117 192839 Tn.M.Djakfar 55th √ Umum Hemangioma antebrachii Excisi Hemangioma antebrachii dr.Hernowo TIVA I
118 206923 Tn.Sudarmadji 43th √ Umum HIL Herniotomy dr.Hernowo SAB VIP
Boneexpose digiti IV manus Boneexpose digiti IV manus
119 419565 Tn.Fajar 43th √ Ortho D
Osteotomy+stam plasty
D dr.Hari C TIVA II
120 233772 Ny.Munawaroh 45th √ Umum Tumor parotis Excisi Tumor parotis dr.Hernowo TIVA II

B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP G2P1A0+BSC OPERATOR INAP
L P HESI

121 292100 Tn.M.Sholeh 34th √ Urologi 14/12/2017 Varicocle Vasoligasi tinggi palomo S Varicocle dr.Kristianto SAB II/TC

122 351883 Ny.Diah Kusuma 42th √ THT Septum deviasi Septo plasti Septum deviasi dr.Noer S Intubasi II

123 418149 Sdr.Faisal F 16th √ Ortho Union fr angkle Aff plate Union fr angkle dr.Danang SAB III/TC

124 419358 Ny.Duhrotul Inaya 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
125 347585 Ny.Pophy Indriana 26th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Umi SAB II/VK

126 000142 Ny.Retno Widya 49th √ Ortho Mal union fr tibia proximal High tibia oestotomy Mal union fr tibia proximal dr.Danang SAB II

127 354793 Ny.Maria Ulfa 25th √ Obgyn Post SC+ILO Debridement+reheacting Post SC+ILO dr.Umi SAB II/VK
SOS+adesiolisis cistectomy Cistoma ovarii coklat
128 419100 Ny.Fanidah 38th √ Obgyn Cistoma ovarii D bilateral dr.Umi SAB II/VK
√ OS asec adeno tonsilitis OS asec adeno tonsilitis
129 419923 An.Almira Zulfa 9th THT
kronis
ATE
kronis
dr.Noer S Intubasi II

130 149629 An.Aysar Arta 9th √ Umum 15/12/2017 HIL Herniotomy+Circumsisi HIL+Phimosis dr.Sukarno Masker III/TC

131 223335 Ny.Ari Dwi S 35th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Umi SAB II/VK

132 368363 Ny.Diah Murtanti 35th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK

133 219279 Ny.Nurul Utami 28th √ Obgyn G4P2A1+BSC LSCS G4P2A1+BSC dr.Umi SAB II/VK

134 416997 Ny.Firrafaul C 24th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB II/VK

135 420205 Ny.Ariyanti Martini 41th √ Obgyn 16/12/2017 Total ruptul perineum Heating Total ruptul perineum dr.Kery SAB III/VK

136 346740 Ny.Putri ayu C 26th √ Obgyn Ab.Incompleitus Curetage Ab.Incompleitus dr.Kery SAB VVIP

137 271437 Ny.Nafilatus 17th √ Umum Ganglion wrist Excisi Ganglion wrist dr.Hernowo Masker I

138 420195 Tn.Rudy Sutomo 39th √ Ortho Cl.Fr.radius ulna Orifpinning Cl.Fr.radius ulna dr.Hernowo Intubasi II/TC

139 414310 Tn.Supriyanto 40th √ Umum Appendicitis kronis Appendictomy Appendicitis kronis dr.Hernowo SAB II/TC

140 420218 Sdr.Annafi Akdya 20th √ Ortho Cross injuri digiti I manus D Debridement+pining stump Cross injuri digiti I manus D dr.Danang Masker III/TC

: UMUM EL: B: BERSIH KTR : KOTOR


BPJS : BPJS CY: 50t BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
141 154350 Ny.Imas Anggi 27th √ Obgyn 16/12/2017 G1P0A0+Infeksi intra uteri LSCS G1P0A0+Infeksi intra uteri dr.Umi SAB II/VK
Cross injuru digiti V manus Cross injuru digiti V manus
142 335595 Tn.Jainul Arifin 49th √ Ortho D
Debridement+repair stump
D dr.Danang Masker I III/TC
Dislokasi elbow post Dislokasi elbow post
143 252252 Tn.Risvi Iqbal 31th √ Ortho debridement Orif pining debridement dr.Danang Intubasi III/TC
144 315705 Ny.Dewi Khumairo 26th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
145 419552 Ny.Dian Suryandari 24th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
146 264098 Ny.Nikmatus 39th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB III/VK
147 419982 Ny.Maya Kusuma 35th √ Obgyn 17/12/2017 G3P2A0+BSC+HbSAg+ LSCS+MOW G3P2A0+BSC+HbSAg+ dr.Umi SAB II/VK
148 419380 Ny.Iif Sua'ibah 23th √ Obgyn 18/12/2017 G1P0A0+Letsu LSCS G1P0A0+Letsu dr.Haris SAB VVIPA
149 420312 Ny.Eka Andriani 29th √ Obgyn G2P1A0+BSC LSCS+Insersi IUD G2P1A0+BSC dr.Haris SAB II/VK
150 420268 Sdr.Ahmad H 28th √ Umum Phlegmon Drainage Phlegmon dr.Yan P TIVA II/TC
151 174252 Ny.Siti Ningrum 72th √ Umum Appendik perforasi Laparatomy Appendik perforasi dr.Yan P Intubasi II
G2P1A0+BSC+Ket
152 376994 Ny.Atik Mufaridah 28th √ Obgyn G2P1A0+BSC LSCS mekoneal dr.Umi SAB I/VK
153 420213 Ny.Ana Eka 50th √ Umum Ulkus pedis S Incisi+debridement Ulkus pedis S dr.Hernowo SAB VVIPA
Ruptur ligamen colateral Rekontruksi ligamen Ruptur ligamen colateral
154 420352 Tn.Arsy R 28th √ Ortho genue D colateral genue D genue D dr.Hari C SAB II/TC
155 418654 Ny.Sri Handayani 48th √ Ortho Trigger finger digiti II manus Release tendon hand Trigger finger digiti II manus dr.Danang Masker I I/TC
√ Post wiring dan reposisi Post wiring dan reposisi
156 228477 Ny.Masudah 45th Umum maxilla
Aff suspensi dan achbar
maxilla dr.Hernowo Intubasi VVIPB
√ Bdh mulut Aff gigi dr.Henry
157 413778 Ny.Ratna S 40th √ Obgyn KET Salpingectomy D Ruptur tuba pars ampularis dr.Umi SAB III/VK
158 405436 Ny.Elva Mutiara 28th √ Obgyn 19/12/2017 G4P3A0+APB LSCS+MOW G4P3A0+PP dr.Kery SAB II/VK
159 279589 Ny.Siti Rufidah 49th √ Obgyn Mioma uteri SOS+SVH Mioma uteri+cistoma ovarii dr.Kery SAB VVIPB
160 405893 Ny.Masulum 35th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
161 416987 Ny.Satumi 38th √ Obgyn 19/12/2017 G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB II/VK
162 416325 Ny.Siti Fatima 38th √ Obgyn Cistoma ovarii Cistectomy+miomectomy Cistoma ov+mioma uteri dr.Kery SAB I/VK
163 420427 Ny.Lidyawati 34th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB III/VK
164 414534 Tn.Widianto 36th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
165 403365 Ny.Aryanti Retna √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
166 416804 Tn.Lutfi Ihsan 43th √ Anestesi CKD Pasang CVC CKD dr.Sutrisno LA RJ
167 313707 Tn.Endra Sugeng 52th √ Ortho Tringger thrumb manus D Release tendon Tringger thrumb manus D dr.Danang Masker I
168 415767 Tn.Arijo Waspada 60th √ Urologi BPH TUR Prostat BPH dr.Kristianto SAB II/TC
169 420461 Ny.Heny Eka 27th √ Obgyn G1P0A0+Oligohidramnion LSCS G1P0A0+Oligohidramnion dr.Umi SAB II/VK
170 420519 Ny.Ningatun 34th √ Obgyn G5P4A1+PEB LSCS+MOW G5P4A1+PEB dr.Umi SAB II/VK
171 420353 Tn.M.Ilyas 61th √ Umum 20/12/2017 Gangliom pedis+DM Debridement Gangliom pedis+DM dr.Yan P SAB I
172 420442 Ny.Suhartiningsih 33th √ Obgyn G2P1A0+Letsu LSCS G2P1A0+Letsu dr.Kery SAB II/VK
173 288391 Ny.Sulistinah 29th √ Obgyn G2P1A0 +BSC LSCS G2P1A0 +BSC dr.Kery SAB III/VK
174 373672 Ny.Sukiyati 42th √ Obgyn G4PA2+Letsu LSCS+MOW G4PA2+Letsu dr.Kery SAB III/VK
175 1925595 Ny.Dwi Agung W 32th √ Obgyn G2P1A0TH +BSC LSCS G2P1A0TH +BSC dr.Kery SAB II/VK
176 409815 Ny.Erlin A 37th √ Obgyn G3P2A0+PPT LSCS+MOW G3P2A0+PPT dr.Kery SAB II/VK
177 419242 Ny.Nur khayati 56th √ Umum Struma nodusa Total lobectomy Struma nodusa dr.Hernowo Intubasi III
G3P2A0=BSC+Ket
178 414777 Ny.Yuli R 25th √ Obgyn G3P2A0+BSC LSCS mekoneal dr.Umi SAB I/VK
179 413905 Ny.Endah Sulistyo 34th √ Obgyn G2P1A0+PEB +BSC LSCS G2P1A0+PEB +BSC dr.Umi SAB II/VK
180 375568 Ny.Anisa E 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR DX DX JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
ISASI OPERATOR INAP
HESI
JNS
SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI TINDAKAN ANAST
KH B S K ISASI PRE OP POST OP OPERATOR INAP
L P HESI
G2P1A0+BSC+Ket
181 238618 Ny.Maya Farida 27th √ Obgyn 21/12/2017 G2P1A0+BSC LSCS+Insersi IUD mekoneal dr.Umi SAB I/VK
182 410182 Ny.Herlin M 40th √ Obgyn G4P3A0+BSC LSCS+MOW G4P3A0+BSC dr.Kery SAB II/VK
183 216018 Ny.Nike Ayu P 26th √ Obgyn G2P1A0 +BSC LSCS G2P1A0 +BSC dr.Kery SAB III/VK
184 420633 Ny.Dwi Putrisari 23th √ Obgyn G1P1A0+Letsu LSCS G1P1A0+Letsu dr.Kery SAB II/VK
185 419441 Ny.Umrotul K 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Heru SAB II/VK
186 420623 Ny.Selvy Indah 23th √ Obgyn G1P1A0+Hemoroid LSCS G1P1A0+Hemoroid dr.Kery SAB II/VK
187 311385 Sdr.Ahmad Wildan 16th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Yan P Masker I
188 211645 Tn.Sumarno 46th √ Umum Perianal abces+DM Debridement Perianal abces+DM dr.Yan P SAB II
189 382249 Ny.Hery Triastutik 45th √ Ortho Trigger tamp manus Reales tendon hand Trigger tamp manus dr.Danang Masker II
190 172342 An.Diaz Syahreza 8th √ Bdh mulut Soft tissu tumor Excisi Soft tissu tumor dr.Henry TIVA II
191 388835 Tn.Sutikno 35th √ Ortho Cl.Fr. Clafikula S Orif plating Cl.Fr. Clafikula S dr.Danang Intubasi III/TC
192 218833 Sdr,Dedy Andrianto 22th √ Ortho Malinio fr. Phalang osteotomy+pinning Malinio fr. Phalang dr.Danang SAB II/TC
193 347963 Ny.Eka mery 23th √ Obgyn G2P1A0 +BSC LSCS G2P1A0 +BSC dr.Umi SAB I/VK
194 419478 Ny.Ayu Hapsari 23th √ Obgyn G1P0A0+High miopi LSCS G1P0A0+High miopi dr.Umi SAB VVIP
195 393370 Ny.dr.Siti Hana 36th √ Obgyn G3P2A0+BSC LSCS G3P2A0+BSC dr.Umi SAB I/VK
196 349013 Ny.Tunik 80th √ Urologi Ca. Buli Sistoscopy Ca. Buli dr.Kristianto SAB III/TC
197 338601 An.Hajida Sinta 12th √ THT Adenotonsilitis C ATE Adenotonsilitis C dr.Noer Sofi Intubasi II/TC
198 264416 Sdr.Jody Dimad 15th √ THT Adenotonsilitis C ATE Adenotonsilitis C dr.Noer Sofi Intubasi I/TC
199 409745 Tn.Priyo Santoso 44th √ Umum 22/12/2017 Tumor punggung Excisi Tumor punggung dr.Yan P TIVA II/TC
200 416989 Nn.Hanum Siti 21th √ Umum FAM D Excisi FAM D dr.Hernowo TIVA III

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
201 407668 An.Nazilla Putri 13th √ Umum 12/22/2017 Tumor genu D Excisi Tumor genu D dr.Hernowo TIVA II/TC
202 420553 Ny.Catur Yanuar 41th √ Umum Tumor scapula Excisi Tumor scapula dr.Hernowo TIVA I/TC
203 420562 Sdr.Riyan Ardi 15th √ Umum Tumor scal posterior Excisi Tumor scal posterior dr.Hernowo TIVA III
204 227741 Tn.Agus Budi 40th √ ortho Cl fr tibia D Orif plating Cl fr tibia D dr.Danang SAB I
205 420453 Ny.Ina Diah 40th √ Obgyn G4P1A2+PEB LSCS G4P1A2+PEB dr.Umi SAB I/VK
206 419219 Ny.Farah Finari 31th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Umi SAB II/VK
207 405097 Ny.Renti Nur I 27th √ Obgyn G3P0A2+PEB LSCS G3P0A2+PEB dr.Umi SAB II/VK
208 213731 Ny.Doria Baluarti 37th √ Obgyn G3P2A0+BSC LSCS+MOW G3P2A0+BSC dr.Umi SAB II/VK
209 420810 Sdr.M Jainuri 28th √ Umum Ring contriksi Extraksi ring Ring contriksi dr.Hernowo masker II
210 420837 Ny.Siti Julaikah 41th √ Obgyn 12/23/2017 G2P1A0+PEB+BSC LSCS G2P1A0+PEB+BSC dr.Kery SAB II/VK
211 420821 Ny.Evi Putri 25th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
212 419828 Tn.Abdul Mansyur 64th √ Umum CKD AV Shunt CKD dr.Hernowo LA RJ
213 417076 Nn.Noviana K 40th √ Umum HIL D Herniotomy HIL D dr.Hernowo SAB II
214 155002 Nn.Ataya Shofa 17th √ ortho Union fr radius ulna Aff plate Union fr radius ulna dr.Danang masker VVIP
215 420699 Nn.Salwa Izzah 16th √ Umum Tumor punggung Excisi Tumor punggung dr.Yan P TIVA I/TC
216 418988 Sdr.Moh. Fahrizal 24th √ Umum Tumor pedis S Excisi Tumor pedis S dr.Yan P SAB I/TC
217 420855 Ny.Eka Hani M 39th √ Obgyn 12/24/2017 G3P2A0+faetal distres LSCS+MOW G3P2A0+faetal distres dr.Umi SAB II/VK
218 420707 An.M. Reza M 1th √ Umum GEA + Vomiting Vena sectie GEA + Vomiting dr.Hernowo LA III

219 358464 Ny.Asih Lestari 23th √ Obgyn 12/25/2017 G1P0A0+PRM LSCS G1P0A0+PRM dr.Kery SAB II/VK
220 307994 Ny.Anies Evasari 37th √ Obgyn G3P2A0+PP LSCS G3P2A0+PP dr.Kery SAB VVIP
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
221 346857 Tn.Adi Setiawan 33th √ Umum 12/26/2017 CKD AV shunt CKD dr.Hernowo LA RJ
222 292656 Ny.Siti Aminah 44th √ Obgyn G4P2A1+Primitua LSCS +MOW G4P2A1+Primitua dr.Kery SAB II/VK
223 407146 Ny.Riskinah √ Obgyn G1P0A0+Haemoroid LSCS G1P0A0+Haemoroid dr.Kery SAB II/VK
224 420865 Ny.Nurul Ismayani 31th √ Umum FAM Excisi FAM dr.Hernowo Masker I/VK
225 390339 Ny.Yuli Mardani 33th √ Obgyn G3P2A1+BSC LSCS G3P2A1+BSC dr.Kery SAB II/VK
226 420879 Nn.Nadia Rahma 14th √ Umum Tumor bracialis Excisi Tumor bracialis dr.Hernowo TIVA II/VK
227 385568 An.Arjuna Riziq 1th √ Umum HIL S Herniotomy HIL S dr.Hernowo SAB II/TC
228 347221 Ny.Zulaikah 48th √ Umum Apendicitis cronic Apendictomy Apendicitis cronic dr.Hernowo SAB II/TC
229 420621 Ny.Misriyani 40th √ Umum Tumor coli posterior Excisi Tumor coli posterior dr.Hernowo TIVA II
230 420380 Ny.Maskamah 27th √ Obgyn G1P0A0 +PRM LSCS G1P0A0 +PRM dr.Kery SAB II/TC
231 421057 An.M Adam F 11th √ Umum 12/27/2017 Ganglion ankle Excisi Ganglion ankle dr.Yan P TIVA II/TC
232 420856 Ny.Siti Umami 40th √ Obgyn Mioma uteri SVH Mioma uteri dr.Kery SAB II/VK
233 364351 Ny.Poniti 42th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Yan P Masker II/TC
234 419333 Ny.Wulan Dwi 27th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
235 215431 Ny.Lis Makhiluk 37th √ Umum Tumor paha Excisi Tumor paha dr.Yan P SAB II
236 300341 Ny.Syafaatul 44th √ Umum Ganglion manus S Excisi Ganglion manus S dr.Hernowo Masker III/TC
237 312944 Nn.Dwi Widya 19th √ Umum Ganglion manus S Excisi Ganglion manus S dr.Hernowo Masker I
238 420385 Nn.Michella F 17th √ Umum Ganglion pedis D Excisi Ganglion pedis D dr.Hernowo SAB I
Triger figger digiti III,IV Triger figger digiti III,IV
239 344324 An.Wildan T 2th √ Ortho manus S
Realese tendon hand manus S dr.Danang Masker II/TC
Triger figger digiti IIImanus Triger figger digiti IIImanus
240 269401 Tn.Nur Mochamad 46th √ Ortho S
Realese tendon hand S dr.Danang Masker II/TC
KETERANGAN :
U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR
BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
241 420545 Ny.Mujayanah 67th √ Umum 12/27/2017 Hernia umbikalis Herniotomy Hernia umbikalis dr.Bambang SAB II
242 392403 Ny.Wa'aisyah 33th √ Obgyn G2P0A1+PEB LSCS+Insersi IUD G2P0A1+PEB dr.Umi SAB II/VK
243 404045 Ny.Khuriyatur R 25th √ Obgyn G1P0A0+CPD LSCS+Insersi IUD G1P0A0+CPD dr.Umi SAB II/VK
244 270340 Ny.Iin Indarsyah 39th √ Obgyn G4P2A1+BSC LSCS+Insersi IUD G4P2A1+BSC dr.Umi SAB III/VK
245 404375 Ny.Suprihatin 45th √ Obgyn 28/12/2017 G3P2A0+PEB LSCS+MOW G3P2A0+PEB dr.Kery SAB III/VK
246 419801 Ny.Betaria Irma 29th √ Obgyn G2P1A0+BSC LSCS G2P1A0+BSC dr.Kery SAB II/VK
247 241835 Ny.Safaatul Islami 32th √ Obgyn G3P1A1+HbSAg + LSCS G3P1A1+HbSAg + dr.Kery SAB II/VK
248 413407 Ny.Suliqah 22th √ Obgyn G1P0A0+PROM LSCS G1P0A0+PROM dr.Umi SAB II/VK
249 421266 Ny.Atik Insiyah 33th √ Obgyn G2P1A0+BSC+PEB LSCS+MOW G2P1A0+BSC+PEB dr.Kery SAB VVIPA
250 420388 An.M.Iqbal Zadit 4th √ Umum HIL S Herniotomy+circumsisi HIL S dr.Hernowo Masker I
251 420213 Ny.Ana Eko W 50th √ Umum Nekrosis pedis+DM Incisi+debriment Nekrosis pedis+DM dr.Hernowo SAB I
252 421268 Ny.Nur Kalimah 36th √ Obgyn G2P1A0+PEB LSCS G2P1A0+PEB dr.Kery SAB III/VK
Union fr clavicula D post Union fr clavicula D post
253 420684 Sdr.Dedit Wi 26th √ Ortho plating Aff plate plating dr.Danang Intubasi II/TC
254 396755 An.Raffa Alfareza 1th √ Urologi Phimosis Circumsisi Phimosis dr.Kristianto Masker RJ
Rekontruksi plating
255 412355 Ny.Amayati 47th √ Ortho Cl fr radius S+dislokasi wrist
radius+wiring wrist
Cl fr radius S+dislokasi wrist dr.Hari C Intubasi II/TC
256 416077 NY.Deby Tri K 33th √ Obgyn G3P1A1+BSC+PPM LSCS+Insersi IUD G3P1A1+BSC+PPM dr.Umi SAB II/VK
257 419869 Ny.Intan Tsamaro 24th √ Obgyn G1P0A0+High miopi LSCS G1P0A0+High miopi dr.Umi SAB III/VK
G6P3A2+BSC+PEB+Ket
258 349270 Ny.Risdian 38th √ Obgyn G6P3A2+BSC+PEB LSCS+Insersi IUD mekoneal dr.Umi SAB II/VK
259 206990 Ny.Rizki Ayu S 28th √ Obgyn G3P1A1+BSC LSCS+Insersi IUD G3P1A1+BSC dr.Umi SAB II/VK
260 341032 Sdr.Lalu Cahya 17th √ THT Tonsilitis cronik ATE Tonsilitis cronik dr.Noer Sofi Intubasi II

: UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI √
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
G2P1A0+PROM+Ket
261 421387 Ny.Sumiati 32th √ Obgyn 29/12/2017 G2P1A0+PROM LSCS mekoneal dr.Umi SAB II/VK
262 192382 Ny.Kiswati 43th √ Umum Struma uni nodusa Sub total lobectomy Struma uni nodusa dr.Yan P Intubasi III
263 385229 Ny.Suryati 40th √ Umum Tumor gluteus S Excisi Tumor gluteus S dr.Hernowo Masker II
G1P0A0+Prolong laten G1P0A0+Prolong laten
264 384233 Nn.Shinta Anggi 25th √ Obgyn phase LSCS phase dr.Kery SAB II/VK
265 385261 Ny.Khusul Rohma 63th √ Umum Ganglion carpi Excisi Ganglion carpi dr.Yan P Masker III
266 223234 Sdr.Ach.Syaifudin 22th √ Umum Fr nasal Reposisi Fr nasal dr.Hernowo Intubasi II
267 420898 Tn.Rianto 49th √ Umum Multiple lipoma Excisi Multiple lipoma dr.Hernowo TIVA II/TC
268 421228 Ny.Novi Dwi S 24th √ Umum FAM multiple Excisi FAM multiple dr.Bambang Masker II/TC
269 420343 Tn.Soemodjo 72th √ Umum HIL S Herniotomy HIL S dr.Bambang SAB II/TC
270 367157 Ny.Kasiani 44th √ Umum Abses punggung Excisi+debridement Abses punggung dr.Bambang TIVA I
271 176131 Ny.Vindyasari 36th √ Umum Cholelitiasis Cholesistectomy Cholelitiasis dr.Hernowo SAB II
272 421277 Nn.Devi Ayu P 15th √ Umum Tumor punggung multiple Excisi Tumor punggung multiple dr.Yan P Masker II/TC
273 395795 Ny.Firdha Maulina 29th √ Obgyn Cistoma ovarii SOS+Oovarectomy Cistoma ovarii coklat dr.Umi SAB II/VK
274 206344 Ny.Tri Pujiati 41th √ Obgyn G2P1A0+KIFL LSCS+MOW G2P1A0+KIFL dr.Kery SAB I/V
G1P0A0+IUFD+Multiple
275 421449 Ny.Merti Herna 34th √ Obgyn 30/12/20107 G1P0A0+IUFD+Mioma uteri SVH mioma uteri dr.Kery SAB II/VK
276 413149 Ny.Devie Aprilia 21th √ Obgyn G1P0A0+PEB LSCS G1P0A0+PEB dr.Kery SAB II/VK
277 178343 An.Keyza Putri D 16th √ Umum Tumor manus D Excisi Tumor manus D dr.Bambang TIVA I/TC
278 420811 Sdr.Ajib Januar 17th √ Umum Tumor colli posterior Excisi Tumor colli posterior dr.Bambang Masker III/TC
279 419828 Tn.Abdullah M 64th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA RJ
280 421189 Ny.Sri Widya 49th √ Anestesi CKD Pasang CVC CKD dr.Ary F LA RJ

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
281 421352 Nn.Nur Maghfiroh 20th √ Umum 30/12/2017 Ulkus pedis S+DM Incisi+debridement Ulkus pedis S+DM dr.Hernowo TIVA III
282 421525 Ny.Isna Wachidah 23th √ Obgyn G1P0A0+PP LSCS G1P0A0+PP dr.Kery SAB I/VK
283 421452 Ny.Suci Afrianti 27th √ Obgyn G1P0A0+NST non reaktif LSCS G1P0A0+NST non reaktif dr.Kery SAB II/VK
284 137203 Ny.Luluk Suprapti 34th √ Obgyn G4P2A1+BSC LSCS G4P2A1+BSC dr.Umi SAB II/VK
G3P2A0+Post term ket
285 253547 Ny.Tri Sena D 35th √ Obgyn 12/31/2017 G3P2A0+Post term LSCS mekoneal dr.Umi SAB II/VK
G1P0A0+Post
286 371667 Ny.Eka Diah A 23th √ Obgyn G1P0A0+Post term+CPD LSCS term+CPD+ket mekoneal dr.Umi SAB II/VK
287 421606 Ny.Oki Nur K 31th √ Obgyn G1P0A0+KIFA+PEB LSCS G1P0A0+KIFA+PEB dr.Umi SAB II/VK
288
289
290
291
292
293
294
295
296
297
298
299
300

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI

LAPORAN PELAYANAN PEMBEDAHAN


DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI
UMUR JNS
OPERASI SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
KH B S K ISASI OPERATOR INAP
L P HESI
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
LAPORAN PELAYANAN PEMBEDAHAN
DI UNIT KAMAR OPERASI RSI SITI HAJAR SIDOARJO
BULAN NOVEMBER TAHUN 2017

KLASSIFIKASI JNS
UMUR SPESIAL DOKTER RWT
NO NO. REG NAMA PASIEN OPERASI TGL OPERASI DX PRE OP TINDAKAN DX POST OP ANAST
ISASI OPERATOR INAP
L P KH B S K HESI
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360

U : UMUM EL: ELEKIF B: BERSIH KTR : KOTOR


BPJS : BPJS CY: CYTO BK: BERSIH KONTAMINASI
As. : ASURANSI K: KONTAMINASI
OARJO

OK WAKTU OPERASI
JDWL OP KAT. LUKA OP BIAYA

ronde EL CY B BK K KTR U BPJS As. sign in time out sign out selesai op
2/I √ √ √

1/I √ √ √

2/II √ √ √

RR √ √ √

3/III √ √ √

3/IV √ √ √

1/I √ √ √

2/II √ √ √
2/I √ √ √
3/I √ √ √
Admedi
3/III √ √ ka

2/II √ √

1/I √ √ fiud
3/I √ √ √
2/I √ √ √

1/II √ √ √

2/II √ √ √

3/III √ √ √

4/I √ √ √

4/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

2/II √ √ √

1/I √ √ √

√ √ √
√ √ √
√ √ √
√ √ √
√ √
√ √ √
√ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
√ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/V √ √ √

3/IV √ √ √

1/IV √ √ √

1/I √ √ JAI

2/I √ √ √

1/II √ √ √

2/II √ √ √

3/II √ √ √

2/II √ √ √

1/III √ √ √

1/I √ √ √

1/II √ √ RBH
2/II √ √ √

2/I √ √ √
RR √ √ √
2/III √ √ √
1/II √ √ √
1/III √ √ √

2/IV √ √ √

1/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

4/I √ √ ketenagakerjaan

2/I √ √ √

3/I √ √

1/I √ √ √

2/II √ √ √

3/I √ √ √

2/III √ √ √

2/IV √ √ √
3/II √ √ √

2/IV √ √ √

4/I √ √ √

4/II √ √ inhealth
3/III √ √ √

2/IV √ √ √

1/I √ √ √

3/II √ √ √

2/I √ √ √

3/I √ √ √

2/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/III √ √ √
4/I √ √ BTN
2/III √ √ √
√ √

3/IV √ √ √

3/V √ √ √

2/III √ √ √

3/V √ √ √

2/IV √ √ √
√ √ √

1/I √ √ √

1/I √ √ √

3/I √ √ √

2/I √ √ √

2/III √ √ √

3/III √ √ √

3/III √ √ √

1/III √ √ √

2/III √ √ √

3/IV √ √ √

3/V √ √ JAI
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

1/III √ √ √

2/V √ √ √

1/IV √ √ √

4/I √ √ ketenagakerjaan

4/II √ √ nippon admedika


2/III √ √ √

3/II √ √ √

2/I √ √ √

1/II √ √ √

1/I √ √ √

3/I √ √ √
1/II √ √ √

1/III √ √ √

2/I √ √ √

2/III √ √ √

3/III √ √ √

2/III √ √ AIA
3/IV √ √ √

2/IV √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/IV √ √ √

4/IV √ √ √

4/I √ √ √

3/V √ √ √
3/VI √ √ √

4/I √ √ √

2/VI √ √ √

2/VII √ √ √

4/III √ √ √

2/I √ √ √

2/II √ √ √

3/I √ √ √

2/III √ √ √

3/II √ √ √

3/I √ √ √

3/I √ √ AIA
2/I √ √ √

4/I √ √ ketenagakerjaan

I/I √ √ √

3/I √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/II √ √ √

4/III √ √ ketenagakerjaan

4/II √ √ admedika
3/II √ √ √

2/II √ √ √

3/III √ √ √

1/I √ √ √

3/I √ √ JAI
2/I √ √ √

1/II √ √ √

1/I √ √ √

3/II √ √ √

1/III √ √ √

4/I √ √ √

3/I √ √ √

2/II √ √ AIA
3/III √ √ √

3/I √ √ √

2/I √ √ √

3/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/II √ √ √

3/II √ √ √

1/I √ √ √

4/I √ √ √

2/III √ KAI
RR √ √ √

4/II √ √ RSI
2/III √ √ √

2/IV √ √ √

1/II √ √ √

2/I √ √ √

2/I √ √ √

4/I √ √ √

2/II √ √ √

4/II √ √ ACA
2/III √ √ √

2/II √ √ √

2/III √ √ √

1/III √ √ √

2/IV √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

3/I √ √ √

2/I √ √ √

2/II √ √ √

1/I √ √ √

3/II √ √ √

1/II √ √ JAPFA
1/III √ √ √

4/I √ √ √

2/III √ √ √

4/II √ √ ketenagakerjaan

4/I √ √ √

1/III √ √ √

3/IV √ √ √

3/IV √ √ √

2/IV √ √ √

4/III √ √ √

4/IV √ √ √

1/I √ √ √
2/II √ √ √
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/I √ √ √

1/II √ √ √

1/III √ √ √

4/I √ √ reliance
2/III √ √ √

2/IV √ √ √

3/III √ √ √

3/III √ √ √

2/IV √ √ √

3/I √ √ √

2/I √ √ √
3/I √ √ √

2/III √ √ √

4/I √ √ AIA
1/II √ √ √

2/III √ √ √

3/I √ √ √

1/I √ √ √

2/I √ √ √

2/III √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
4/I √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √
3/I √ √ √

2/II √ √ √

4/II √ √ √

1/II √ √ √

1/III √ √ √

3/III √ √ √

1/I √ √ √

3/I √ √ √

2/II √ √ √

2/I √ √ √

1/II √ √ √

1/III √ √ √

1/IV √ √ √

2/III √ √ √

4/I √ √ √

4/II √ √ √

Kaur Kamar Operasi

Agus Wiyono
OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
2/IV √ √ √

3/IV √ √ √

2/V √ √ √

3/I √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

3/II √ √ √

3/III √ √ √

2/II √ √ √

1/III √ √ √

3/III √ √ √

4/I √ √ √

4/II √ √ √

2/III √ √ √

2/IV √ √ √
3/IV √ √ √

3/III √ √ √

2/V √ √ √

4/II √ √ √

Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
3/I √ √ √

4/I √ √ √

1/I √ √ √

3/I √ √ √

4/II √ √ √

2/V √ √ comfeed
2/III √ √ √

1/II √ √ √
1/III √ √ √

1/IV √ √ √

2/IV √ √ √

4/III √ √ √

3/V √ √ √

3/VI √ √ √

3/I √ √ √

2/I √ √ √

1/I √ √ √

1/II √ √ √

RR √ √ √

RR √ √ √

Kaur Kamar Operasi

Agus Wiyono

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
1/I √ √ √

3/II √ √ √
2/I √ √ √

3/IV √ √ √

2/I √ √ JAI
3/I √ √ √

3/II √ √ √

Sidoarjo, …………………………….
Kaur Kamar Operasi
Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

OARJO

OK JDWL OP KAT. LUKA OP BIAYA

ronde
EL CY B BK K KTR U BPJS As.
Kaur Kamar Operasi

Agus Wiyono
OARJO

OK JDWL OP KAT. LUKA OP BIAYA


ronde EL CY B BK K KTR U BPJS As.
Sidoarjo, …………………………….
Kaur Kamar Operasi

Agus Wiyono

Você também pode gostar